MEDICARE: AG MOBILE DRAW 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	:	1740912708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AG MOBILE DRAW LLC

Provider Business Mailing Address
First Line	:	4609 CHERRY RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-5985
Country	:	US
Telephone Number	:	561-670-8201
Fax Number	:

Provider Business Practice Location Address
First Line	:	4609 CHERRY RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-5985
Country	:	US
Telephone Number	:	561-670-8201
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RUTH A CAMACHO
Credential	:
Telephone Number	:	561-670-8201

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	06/28/2022

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