Provider Demographics
NPI:1407678501
Name:TENNESSEE MOBILE LABORATORY LLC
Entity type:Organization
Organization Name:TENNESSEE MOBILE LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-659-8803
Mailing Address - Street 1:235 LAFOLLETTE CIR
Mailing Address - Street 2:
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37863-3207
Mailing Address - Country:US
Mailing Address - Phone:865-659-8803
Mailing Address - Fax:
Practice Address - Street 1:235 LAFOLLETTE CIR
Practice Address - Street 2:
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-3207
Practice Address - Country:US
Practice Address - Phone:865-659-8803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical Laboratory