Provider Demographics
NPI:1740942085
Name:IBT-MOBILE TRIAGE
Entity type:Organization
Organization Name:IBT-MOBILE TRIAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:NRCMA, CPT
Authorized Official - Phone:347-872-2304
Mailing Address - Street 1:6349 WALNUT FOREST CT
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-5328
Mailing Address - Country:US
Mailing Address - Phone:134-787-2230
Mailing Address - Fax:
Practice Address - Street 1:6349 WALNUT FOREST CT
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-5328
Practice Address - Country:US
Practice Address - Phone:347-872-2304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ICED BY TRICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty