Provider Demographics
NPI:1972277572
Name:LOGICAL MOBILE LABORATORY
Entity Type:Organization
Organization Name:LOGICAL MOBILE LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL LABORATORY TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKENBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-773-7475
Mailing Address - Street 1:7319 BEACON HILL LN APT 26
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-5994
Mailing Address - Country:US
Mailing Address - Phone:704-773-7475
Mailing Address - Fax:
Practice Address - Street 1:7319 BEACON HILL LN APT 26
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-5994
Practice Address - Country:US
Practice Address - Phone:704-773-7475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyGroup - Multi-Specialty
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty