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General NPI Number Information
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NPI Number | 1821781063
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Entity Type | Organization
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Legal Business Name | 1 STIKK MOBILE RICHMOND
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Dates
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Enumeration Date | 06/01/2023
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Last Update Date | 12/22/2024
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Provider Practice Location Address
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Address Line | 1121 STAINBACK ST APT 3201
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City | PETERSBURG
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State | VA
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Zip | 23803-3969
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Country | US
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Telephone | 318-512-0170
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 STAINBACK ST APT 3201
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City | PETERSBURG
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State | VA
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Zip | 23803-3969
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Country | US
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Telephone | 318-512-0170
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Fax |
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Authorized Official
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Title or Position | OWNERR
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Name | TIFFANY CLINTON
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Credential | CPT.RMA
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Telephone | 318-512-0170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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