=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093479073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCARTHUR MOBILE LABS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2021
-----------------------------------------------------
Last Update Date | 10/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4530 MAGEE AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19135-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-961-9217
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4530 MAGEE AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19135-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-961-9217
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. NICHOLE LEIGH MCARTHUR
-----------------------------------------------------
Credential | CERT. PHLEBOTOMIST
-----------------------------------------------------
Telephone | 267-961-9217
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------