Provider Demographics
NPI:1336408152
Name:MOBILAB DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:MOBILAB DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-831-7111
Mailing Address - Street 1:5904 S COOPER ST
Mailing Address - Street 2:SUITE 104-184
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-4494
Mailing Address - Country:US
Mailing Address - Phone:469-831-7111
Mailing Address - Fax:888-557-1952
Practice Address - Street 1:5904 S COOPER ST
Practice Address - Street 2:SUITE 104-184
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-4494
Practice Address - Country:US
Practice Address - Phone:469-831-7111
Practice Address - Fax:888-557-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile