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General NPI Number Information
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NPI Number | 1922883438
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Entity Type | Organization
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Legal Business Name | BAILEY'S MOBILE LAB
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Dates
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Enumeration Date | 08/31/2023
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Last Update Date | 10/01/2023
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Provider Practice Location Address
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Address Line | 310 MID CONTINENT PLZ STE 604D
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-1763
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Country | US
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Telephone | 870-636-3809
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Fax |
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Provider Business Mailing Address
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Address Line | 310 MID CONTINENT PLZ STE 604D
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-1763
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Country | US
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Telephone | 870-636-3809
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LASHELL MILLER
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Credential |
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Telephone | 870-636-3809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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 #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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