MEDICARE: ADVANCED CLINICAL COLLECTION AND MOBILE LABS LLC

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

General Provider Information

NPI Number	:	1578493904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CLINICAL COLLECTION AND MOBILE LABS LLC

Provider Business Mailing Address
First Line	:	251 MERRITT AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15227-1915
Country	:	US
Telephone Number	:	412-983-3602
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 MERRITT AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15227-1915
Country	:	US
Telephone Number	:	412-983-3602
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EBONI HAWTHORNE
Credential	:
Telephone Number	:	412-983-3602

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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