=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528882768
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABS ON THE GO, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2024
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 E OAK RIDGE DR STE 2000
-----------------------------------------------------
City | HAGERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21740-7890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-582-8563
-----------------------------------------------------
Fax | 240-536-9118
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12608 INDIAN SPRINGS RD
-----------------------------------------------------
City | CLEAR SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21722-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-582-8563
-----------------------------------------------------
Fax | 240-536-9118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TAMMY MILLS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-582-8563
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------