Healthcare Provider Details

I. General information

NPI: 1821980996
Provider Name (Legal Business Name): SLT ALLSCREENS MOBILE TESTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 S PEAR ORCHARD RD STE 106
RIDGELAND MS
39157-4859
US

IV. Provider business mailing address

665 S PEAR ORCHARD RD STE 106
RIDGELAND MS
39157-4859
US

V. Phone/Fax

Practice location:
  • Phone: 601-667-0579
  • Fax: 601-860-9834
Mailing address:
  • Phone: 601-667-0579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. SHAWNER TYSON
Title or Position: OWNER
Credential:
Phone: 601-441-8326