Provider Demographics
NPI:1871291302
Name:5 STAR MOBILE LABS LLC
Entity type:Organization
Organization Name:5 STAR MOBILE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KYIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKS-LANKFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-957-9056
Mailing Address - Street 1:2112 BROADWAY ST NE STE 225
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-3081
Mailing Address - Country:US
Mailing Address - Phone:763-957-9056
Mailing Address - Fax:612-643-9336
Practice Address - Street 1:2112 BROADWAY ST NE STE 225
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-3081
Practice Address - Country:US
Practice Address - Phone:763-957-9056
Practice Address - Fax:612-643-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty