Healthcare Provider Details

I. General information

NPI: 1053178558
Provider Name (Legal Business Name): PHILLIPS MOBILE LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2942 N 24TH ST STE 114
PHOENIX AZ
85016-7849
US

IV. Provider business mailing address

2942 N 24TH ST STE 114
PHOENIX AZ
85016-7849
US

V. Phone/Fax

Practice location:
  • Phone: 866-467-5227
  • Fax: 602-584-5784
Mailing address:
  • Phone: 866-467-5227
  • Fax: 602-584-5784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. NYTISHA MARIE DAVIS
Title or Position: OWNER
Credential:
Phone: 610-245-7838