Provider Demographics
NPI:1629826839
Name:ONDEMAND MOBILE LAB
Entity type:Organization
Organization Name:ONDEMAND MOBILE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SKY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:NRCPT, NRCMA
Authorized Official - Phone:972-948-3072
Mailing Address - Street 1:626 BECK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-2500
Mailing Address - Country:US
Mailing Address - Phone:972-948-3072
Mailing Address - Fax:972-767-3970
Practice Address - Street 1:626 BECK AVE
Practice Address - Street 2:
Practice Address - City:LAKE DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75065-2500
Practice Address - Country:US
Practice Address - Phone:972-948-3072
Practice Address - Fax:972-767-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-11
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory