Healthcare Provider Details

I. General information

NPI: 1720690415
Provider Name (Legal Business Name): GO LABS MOBILE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2020
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 TWO NOTCH RD STE 5
COLUMBIA SC
29223-1612
US

IV. Provider business mailing address

9600 TWO NOTCH RD STE 5
COLUMBIA SC
29223-1612
US

V. Phone/Fax

Practice location:
  • Phone: 803-801-1175
  • Fax: 803-845-1054
Mailing address:
  • Phone: 803-801-1175
  • Fax: 803-845-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YVONNE D HUNTER
Title or Position: LAB DIRECTOR
Credential:
Phone: 803-801-1175