MEDICARE: GO LABS MOBILE SERVICES 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	305S00000X	Point of Service
2	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1720690415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GO LABS MOBILE SERVICES LLC

Provider Business Mailing Address
First Line	:	9600 TWO NOTCH RD STE 5
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-1612
Country	:	US
Telephone Number	:	803-801-1175
Fax Number	:	803-845-1054

Provider Business Practice Location Address
First Line	:	9600 TWO NOTCH RD STE 5
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-1612
Country	:	US
Telephone Number	:	803-801-1175
Fax Number	:	803-845-1054

Authorized Official
Title or Position	:	LAB DIRECTOR
Name	:	YVONNE D HUNTER
Credential	:
Telephone Number	:	803-801-1175

Provider Enumeration Date	:	08/23/2020
Last Update Date	:	12/09/2024

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