Healthcare Provider Details

I. General information

NPI: 1154052900
Provider Name (Legal Business Name): PROMINENT MOBILE LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7773 CAPITAL PEAK LN W APT 104
MEMPHIS TN
38125-1556
US

IV. Provider business mailing address

PO BOX 1923
SOUTHAVEN MS
38671-0022
US

V. Phone/Fax

Practice location:
  • Phone: 978-902-1339
  • Fax:
Mailing address:
  • Phone: 978-902-1339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: TREZESTYVETTE BROOKS
Title or Position: OWNER
Credential:
Phone: 978-902-1339