Healthcare Provider Details

I. General information

NPI: 1386912566
Provider Name (Legal Business Name): PCT MOBLIE LABS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4489 HOAGLAND BLACKSTUB RD
CORTLAND OH
44410-9573
US

IV. Provider business mailing address

4489 HOAGLAND BLACKSTUB RD
CORTLAND OH
44410-9573
US

V. Phone/Fax

Practice location:
  • Phone: 330-501-8588
  • Fax: 330-306-5123
Mailing address:
  • Phone: 330-501-8588
  • Fax: 330-306-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number36D2016180
License Number StateOH

VIII. Authorized Official

Name: CHRISTOPHER F LOMBARD
Title or Position: PRESIDENT
Credential: RN
Phone: 330-501-8588