1 Stikk Mobile Richmond

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

1 STIKK MOBILE RICHMOND

Practice address

1121 Stainback St
Apt 3201
Petersburg, VA 23803-3969

Phone

(318) 512-0170

NPI assigned

Jun 1, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tiffany Clinton, CPT.RMA

Title

Ownerr

Phone

(318) 512-0170

Specialties & licenses 3

Addresses

Other names 1

• 1 Stikk Moblie Laboratory LLC Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734825600000",
    "number": "1821781063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 STAINBACK ST",
            "address_2": "APT 3201",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238033969",
            "telephone_number": "318-512-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 STAINBACK ST",
            "address_2": "APT 3201",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238033969",
            "telephone_number": "318-512-0170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 Timberland Dr NE",
            "address_purpose": "LOCATION",
            "city": "Ludowici",
            "state": "GA",
            "postal_code": "313166669",
            "country_code": "US",
            "telephone_number": "318-512-0170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "1 STIKK MOBILE RICHMOND",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-01",
        "last_updated": "2024-12-22",
        "certification_date": "2024-12-22",
        "status": "A",
        "authorized_official_last_name": "CLINTON",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "OWNERR",
        "authorized_official_telephone_number": "318-512-0170",
        "authorized_official_credential": "CPT.RMA"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "1 Stikk Moblie Laboratory LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "1 Stikk Moblie Laboratory LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• All providers in Petersburg, VA
• Clinical Medical Laboratory in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.