Provider Demographics
NPI:1104018118
Name:MEDICAL LAB ON WHEELS INC
Entity type:Organization
Organization Name:MEDICAL LAB ON WHEELS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-446-6074
Mailing Address - Street 1:3249 ROLAND DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-9402
Mailing Address - Country:US
Mailing Address - Phone:407-732-4808
Mailing Address - Fax:407-732-4809
Practice Address - Street 1:3249 ROLAND DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-9402
Practice Address - Country:US
Practice Address - Phone:407-732-4808
Practice Address - Fax:407-732-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory