=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841972379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONSITE MOBILE LABORATORY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2023
-----------------------------------------------------
Last Update Date | 08/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3942 GARNER RD
-----------------------------------------------------
City | TIMMONSVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29161-9255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 854-903-7960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3942 GARNER RD
-----------------------------------------------------
City | TIMMONSVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29161-9255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 854-903-7960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | CANDACE PAIGE
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 843-484-7303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------