Provider Demographics
NPI:1154590701
Name:ON THE GO MOBILE PHLEBOTOMY SERVICE INC.
Entity type:Organization
Organization Name:ON THE GO MOBILE PHLEBOTOMY SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-847-7711
Mailing Address - Street 1:7018 SAYBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-1124
Mailing Address - Country:US
Mailing Address - Phone:215-847-7711
Mailing Address - Fax:215-921-6827
Practice Address - Street 1:4201 ASPEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1431
Practice Address - Country:US
Practice Address - Phone:215-921-6825
Practice Address - Fax:215-921-6827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3787627291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory