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General NPI Number Information
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NPI Number | 1417847310
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Entity Type | Organization
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Legal Business Name | IDTS-MOBILE SPECIMEN COLLECTION LAB LLC
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 3849 SAINT BARNABAS RD APT T2
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City | SUITLAND
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State | MD
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Zip | 20746-3238
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Country | US
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Telephone | 240-350-2943
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Fax | 866-528-1035
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Provider Business Mailing Address
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Address Line | 3849 SAINT BARNABAS RD APT T2
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City | SUITLAND
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State | MD
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Zip | 20746-3238
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Country | US
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Telephone | 240-350-2943
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Fax | 866-528-1035
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Authorized Official
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Title or Position | OWNER/DOT COLLECTOR
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Name | MS. PHYLLIS SMITH
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Credential | NA
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Telephone | 240-350-2943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0006X
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Taxonomy Name | Clinical Pathology Physician
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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