Healthcare Provider Details

I. General information

NPI: 1992643597
Provider Name (Legal Business Name): MOBILE DIAGNOSTIC LABORATORY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 WEST PULLEN AVENUE
PINE BLUFF AR
71601-3441
US

IV. Provider business mailing address

703 WEST PULLEN AVENUE
PINE BLUFF AR
71601-3441
US

V. Phone/Fax

Practice location:
  • Phone: 870-433-0096
  • Fax: 870-433-0686
Mailing address:
  • Phone: 870-433-0096
  • Fax: 870-433-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH HOWARD TROTTER
Title or Position: DIRECTOR
Credential: M.D.
Phone: 870-433-0096