Provider Demographics
NPI:1740978576
Name:SOUTHERN MARYLAND MOBILE LAB SERVICES LLC
Entity type:Organization
Organization Name:SOUTHERN MARYLAND MOBILE LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TEAIRA
Authorized Official - Middle Name:GENEVA
Authorized Official - Last Name:MILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-925-9449
Mailing Address - Street 1:3828 LAKEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1429
Mailing Address - Country:US
Mailing Address - Phone:240-929-5944
Mailing Address - Fax:240-607-7229
Practice Address - Street 1:3965 SAINT CHARLES PKWY
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2683
Practice Address - Country:US
Practice Address - Phone:240-538-8571
Practice Address - Fax:240-607-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory