Healthcare Provider Details

I. General information

NPI: 1417847310
Provider Name (Legal Business Name): IDTS-MOBILE SPECIMEN COLLECTION LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3849 SAINT BARNABAS RD APT T2
SUITLAND MD
20746-3238
US

IV. Provider business mailing address

3849 SAINT BARNABAS RD APT T2
SUITLAND MD
20746-3238
US

V. Phone/Fax

Practice location:
  • Phone: 240-350-2943
  • Fax: 866-528-1035
Mailing address:
  • Phone: 240-350-2943
  • Fax: 866-528-1035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PHYLLIS SMITH
Title or Position: OWNER/DOT COLLECTOR
Credential: NA
Phone: 240-350-2943