MEDICARE: BLOODCARE INC

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	:	1235306317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOODCARE INC

Provider Business Mailing Address
First Line	:	5605 COVENTRY PARK DR
Second Line	:	SUITE 2010
City	:	HALTOM CITY
State	:	TX
Zip	:	76117-1549
Country	:	US
Telephone Number	:	940-594-4672
Fax Number	:

Provider Business Practice Location Address
First Line	:	5605 COVENTRY PARK DR
Second Line	:	SUITE 2010
City	:	HALTOM CITY
State	:	TX
Zip	:	76117-1549
Country	:	US
Telephone Number	:	940-594-4672
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JEANETTE SIMES HICKS
Credential	:	PHLEBOTOMIST
Telephone Number	:	940-594-4672

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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