Provider Demographics
NPI:1013678358
Name:EXCLUSIVE MOBILE LAB SERVICE
Entity Type:Organization
Organization Name:EXCLUSIVE MOBILE LAB SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DARBY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-613-0171
Mailing Address - Street 1:11745 VIRGIL
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1467
Mailing Address - Country:US
Mailing Address - Phone:313-613-0171
Mailing Address - Fax:
Practice Address - Street 1:11745 VIRGIL
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1467
Practice Address - Country:US
Practice Address - Phone:313-613-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-08
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory