MEDICARE: GENTLE STICKS MOBILE PHLEBOTOMY

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1396362414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE STICKS MOBILE PHLEBOTOMY

Provider Business Mailing Address
First Line	:	4371 CHARLOTTE HWY STE 22
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8105
Country	:	US
Telephone Number	:	803-589-7999
Fax Number	:	803-589-7998

Provider Business Practice Location Address
First Line	:	4371 CHARLOTTE HWY STE 22
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8105
Country	:	US
Telephone Number	:	803-589-7999
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KANNESHA COLEMAN
Credential	:	CPT, CNA, MED TECH
Telephone Number	:	803-589-7999

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	09/28/2023

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Directions to “GENTLE STICKS MOBILE PHLEBOTOMY ” Practice Location

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