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General NPI Number Information
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NPI Number | 1154052900
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Entity Type | Organization
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Legal Business Name | PROMINENT MOBILE LABS LLC
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 7773 CAPITAL PEAK LN W APT 104
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City | MEMPHIS
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State | TN
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Zip | 38125-1556
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Country | US
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Telephone | 978-902-1339
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1923
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City | SOUTHAVEN
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State | MS
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Zip | 38671-0022
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Country | US
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Telephone | 978-902-1339
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TREZESTYVETTE BROOKS
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Credential |
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Telephone | 978-902-1339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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