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General NPI Number Information
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NPI Number | 1962784611
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Entity Type | Organization
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Legal Business Name | AM MOBILE BLOODWORK LLC
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Dates
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Enumeration Date | 09/19/2011
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 2501 HOUMA BLVD STE A
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City | METAIRIE
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State | LA
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Zip | 70001-1392
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Country | US
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Telephone | 504-939-3329
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 HOUMA BLVD STE A
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City | METAIRIE
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State | LA
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Zip | 70001-1392
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Country | US
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Telephone | 504-939-3329
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Fax |
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Authorized Official
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Title or Position | PHLEBOTOMY
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Name | MRS. AMY NELLON
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Credential |
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Telephone | 504-939-3329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLP.202293-PHL
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License Number State | LA
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