Provider Demographics
NPI:1205571122
Name:KDS MOBILE LAB TESTING LLC
Entity type:Organization
Organization Name:KDS MOBILE LAB TESTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-624-9693
Mailing Address - Street 1:5521 SW 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5705
Mailing Address - Country:US
Mailing Address - Phone:863-313-0378
Mailing Address - Fax:866-926-1067
Practice Address - Street 1:5521 SW 99TH AVE
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-5705
Practice Address - Country:US
Practice Address - Phone:863-313-0378
Practice Address - Fax:866-926-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory