1063879070 NPI number — COMPLETE MOBILE LAB SERVICE, LLC

Table of content: DONALD VERNON BLOWER M.D. (NPI 1932156817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063879070 NPI number — COMPLETE MOBILE LAB SERVICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE MOBILE LAB SERVICE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063879070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 79
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18337-0079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-625-3295
Provider Business Mailing Address Fax Number:
570-227-0269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 KEYSTONE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DINGMANS FERRY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18328-4421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-625-3295
Provider Business Practice Location Address Fax Number:
570-227-0269
Provider Enumeration Date:
01/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
STANLEY
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
TIMOTHY
Authorized Official Title or Position:
PHLEBOTOMIST
Authorized Official Telephone Number:
201-625-3295

Provider Taxonomy Codes

  • Taxonomy code: 246RP1900X , with the licence number:  180080 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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