Provider Demographics
NPI:1700691789
Name:TRAVELING SEASIDE MOBILE LAB
Entity type:Organization
Organization Name:TRAVELING SEASIDE MOBILE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERELLE
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPT-1
Authorized Official - Phone:404-447-6279
Mailing Address - Street 1:1333 COLLEGE PKWY STE 622
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2711
Mailing Address - Country:US
Mailing Address - Phone:404-447-6279
Mailing Address - Fax:972-767-3970
Practice Address - Street 1:3001 GRAF BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4114
Practice Address - Country:US
Practice Address - Phone:404-447-6279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory