Healthcare Provider Details

I. General information

NPI: 1619550597
Provider Name (Legal Business Name): MODERN MOBILE LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 NORTHBOROUGH LN
LINCOLN NE
68505-2554
US

IV. Provider business mailing address

730 NORTHBOROUGH LN
LINCOLN NE
68505-2554
US

V. Phone/Fax

Practice location:
  • Phone: 402-269-0671
  • Fax:
Mailing address:
  • Phone: 402-269-0671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGELICA MARTINEZ GOMEZ
Title or Position: OWNER
Credential:
Phone: 402-413-1815