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General NPI Number Information
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NPI Number | 1356148100
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Entity Type | Organization
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Legal Business Name | STICK AND GO MOBILE LAB SERVICES
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 2015 W WESTERN AVE
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City | SOUTH BEND
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State | IN
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Zip | 46619-3544
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Country | US
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Telephone | 800-820-8210
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Fax |
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Provider Business Mailing Address
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Address Line | 137 S SHERIDAN ST
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City | SOUTH BEND
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State | IN
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Zip | 46619-1858
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Country | US
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Telephone | 708-714-4935
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Fax |
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Authorized Official
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Title or Position | TRAVEL PHLEBOTOMIST
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Name | JAZMINE BROOKS
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Credential | CPT
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Telephone | 708-714-4935
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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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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 331L00000X
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Taxonomy Name | Blood Bank
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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