Healthcare Provider Details

I. General information

NPI: 1528882768
Provider Name (Legal Business Name): LABS ON THE GO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E OAK RIDGE DR STE 2000
HAGERSTOWN MD
21740-7890
US

IV. Provider business mailing address

12608 INDIAN SPRINGS RD
CLEAR SPRING MD
21722-1307
US

V. Phone/Fax

Practice location:
  • Phone: 301-582-8563
  • Fax: 240-536-9118
Mailing address:
  • Phone: 301-582-8563
  • Fax: 240-536-9118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TAMMY MILLS
Title or Position: OWNER
Credential:
Phone: 301-582-8563