Provider Demographics
NPI:1588346142
Name:MEDPRO MOBILE LLC
Entity type:Organization
Organization Name:MEDPRO MOBILE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-359-2946
Mailing Address - Street 1:201 ELIZABETH ST # B2S6
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-2133
Mailing Address - Country:US
Mailing Address - Phone:205-359-2946
Mailing Address - Fax:
Practice Address - Street 1:201 ELIZABETH ST # B2S6
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-2133
Practice Address - Country:US
Practice Address - Phone:205-359-2946
Practice Address - Fax:844-440-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory