MEDICARE: SOFT TOUCH MOBILE LAB SERVICES

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	828224	FL

General Provider Information

NPI Number	:	1811347891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOFT TOUCH MOBILE LAB SERVICES

Provider Business Mailing Address
First Line	:	1471 NW 22ND CT
Second Line	:	1
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-3545
Country	:	US
Telephone Number	:	954-709-9849
Fax Number	:

Provider Business Practice Location Address
First Line	:	1471 NW 22ND CT
Second Line	:	1
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-3545
Country	:	US
Telephone Number	:	954-709-9849
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ANDREKIA WILLIAMS-MONTGOMERY
Credential	:	NCPT, NCMA
Telephone Number	:	954-709-9849

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	06/21/2016

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