MEDICARE: SMOOTH STICK 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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1720927452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMOOTH STICK MOBILE LABS LLC

Provider Business Mailing Address
First Line	:	4500 MERCANTILE PLAZA DR STE 300
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76137-4206
Country	:	US
Telephone Number	:	682-267-1227
Fax Number	:	817-580-7191

Provider Business Practice Location Address
First Line	:	4500 MERCANTILE PLAZA DR STE 300
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76137-4206
Country	:	US
Telephone Number	:	682-267-1227
Fax Number	:	817-580-7191

Authorized Official
Title or Position	:	PHLEBOTOMIST
Name	:	BELINDA RUSSELL
Credential	:	NCPT NCMA
Telephone Number	:	682-267-1227

Provider Enumeration Date	:	03/27/2026
Last Update Date	:	03/27/2026

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