Provider Demographics
NPI:1588114706
Name:AMEEN MOBILE LABORATORY AML
Entity type:Organization
Organization Name:AMEEN MOBILE LABORATORY AML
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:EASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-773-4397
Mailing Address - Street 1:11654 VIRGIL
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1447
Mailing Address - Country:US
Mailing Address - Phone:313-773-4397
Mailing Address - Fax:
Practice Address - Street 1:11654 VIRGIL
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1447
Practice Address - Country:US
Practice Address - Phone:313-773-4397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service