Provider Demographics
NPI:1184449704
Name:RIVERSIDE MOBILE LABS LLC
Entity type:Organization
Organization Name:RIVERSIDE MOBILE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHLEBOTOMIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZOPFI
Authorized Official - Suffix:
Authorized Official - Credentials:PBT ASCP
Authorized Official - Phone:715-572-1959
Mailing Address - Street 1:444 RIVER RD E
Mailing Address - Street 2:
Mailing Address - City:RUDOLPH
Mailing Address - State:WI
Mailing Address - Zip Code:54475-9563
Mailing Address - Country:US
Mailing Address - Phone:715-423-1959
Mailing Address - Fax:715-304-2920
Practice Address - Street 1:444 RIVER RD E
Practice Address - Street 2:
Practice Address - City:RUDOLPH
Practice Address - State:WI
Practice Address - Zip Code:54475-9563
Practice Address - Country:US
Practice Address - Phone:715-423-1959
Practice Address - Fax:715-304-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory