MEDICARE: PLEASANT JOURNEY MOBILE LAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1568118925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT JOURNEY MOBILE LAB

Provider Business Mailing Address
First Line	:	100 RUE SAINT FRANCOIS ST STE 206
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-5132
Country	:	US
Telephone Number	:	314-733-5415
Fax Number	:	314-230-9731

Provider Business Practice Location Address
First Line	:	100 RUE SAINT FRANCOIS ST STE 206
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-5132
Country	:	US
Telephone Number	:	314-733-5415
Fax Number	:	314-230-9731

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ROSALIND COKER
Credential	:
Telephone Number	:	314-283-3458

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	02/24/2022

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