Provider Demographics
NPI:1962292276
Name:MOBILE DNA DIRECT LLC
Entity type:Organization
Organization Name:MOBILE DNA DIRECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR/ OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:TASHAE
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-201-2345
Mailing Address - Street 1:3901 W 86TH ST STE 360
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1799
Mailing Address - Country:US
Mailing Address - Phone:866-201-2345
Mailing Address - Fax:
Practice Address - Street 1:3901 W 86TH ST STE 360
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1799
Practice Address - Country:US
Practice Address - Phone:866-201-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty