Provider Demographics
NPI:1356148100
Name:STICK AND GO MOBILE LAB SERVICES
Entity type:Organization
Organization Name:STICK AND GO MOBILE LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRAVEL PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:JAZMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:708-714-4935
Mailing Address - Street 1:137 S SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619-1858
Mailing Address - Country:US
Mailing Address - Phone:708-714-4935
Mailing Address - Fax:
Practice Address - Street 1:2015 W WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-3544
Practice Address - Country:US
Practice Address - Phone:800-820-8210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No331L00000XSuppliersBlood Bank
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1396558912Medicaid