MEDICARE: MOBILE TECH MEDICAL INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	19D1001395	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18313	OTHER		PTAN

General Provider Information

NPI Number	:	1073577730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE TECH MEDICAL INC.

Provider Business Mailing Address
First Line	:	4336 NORTH BLVD STE 200
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3920
Country	:	US
Telephone Number	:	225-267-6860
Fax Number	:	225-344-1133

Provider Business Practice Location Address
First Line	:	4336 NORTH BLVD STE 200
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3920
Country	:	US
Telephone Number	:	225-267-6860
Fax Number	:	225-344-1133

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RONALD A JENKINS
Credential	:	N/A
Telephone Number	:	225-267-6860

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	01/08/2016

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Directions to “MOBILE TECH MEDICAL INC. ” Practice Location

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