MEDICARE: SOUTHERN MOBILE LABS

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	:	1942800685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN MOBILE LABS

Provider Business Mailing Address
First Line	:	4132 RENOVA AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-4281
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4132 RENOVA AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-4281
Country	:	US
Telephone Number	:	941-457-3591
Fax Number	:

Authorized Official
Title or Position	:	PHLEBOTOMIST
Name	:	JANIS MARIE SPURLOCK
Credential	:
Telephone Number	:	941-457-3591

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/30/2020

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Directions to “SOUTHERN MOBILE LABS ” Practice Location

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