Provider Demographics
NPI:1063879070
Name:COMPLETE MOBILE LAB SERVICE, LLC
Entity type:Organization
Organization Name:COMPLETE MOBILE LAB SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMIST/ MA
Authorized Official - Phone:201-625-3295
Mailing Address - Street 1:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-0079
Mailing Address - Country:US
Mailing Address - Phone:201-625-3295
Mailing Address - Fax:570-227-0269
Practice Address - Street 1:105 KEYSTONE DR
Practice Address - Street 2:
Practice Address - City:DINGMANS FERRY
Practice Address - State:PA
Practice Address - Zip Code:18328-4421
Practice Address - Country:US
Practice Address - Phone:201-625-3295
Practice Address - Fax:570-227-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA180080246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty