Provider Demographics
NPI:1841972379
Name:ONSITE MOBILE LABORATORY SERVICES
Entity type:Organization
Organization Name:ONSITE MOBILE LABORATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAIGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:843-484-7303
Mailing Address - Street 1:3942 GARNER RD
Mailing Address - Street 2:
Mailing Address - City:TIMMONSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29161-9255
Mailing Address - Country:US
Mailing Address - Phone:854-903-7960
Mailing Address - Fax:
Practice Address - Street 1:3942 GARNER RD
Practice Address - Street 2:
Practice Address - City:TIMMONSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29161-9255
Practice Address - Country:US
Practice Address - Phone:854-903-7960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service