Healthcare Provider Details

I. General information

NPI: 1972257327
Provider Name (Legal Business Name): HEALTH ALLIANCE MOBILE TESTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BLUESTEM CT
GREENSBORO NC
27405-8224
US

IV. Provider business mailing address

22 BLUESTEM CT
GREENSBORO NC
27405-8224
US

V. Phone/Fax

Practice location:
  • Phone: 336-707-7920
  • Fax:
Mailing address:
  • Phone: 336-707-7920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY TEACHEY
Title or Position: OWNER
Credential: RN
Phone: 540-915-5056