Healthcare Provider Details

I. General information

NPI: 1750135620
Provider Name (Legal Business Name): CLEARTRUST MOBILE PHLEBOTOMY LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 COUNTY ROAD 450
SARDIS AL
36775-3024
US

IV. Provider business mailing address

164 COUNTY ROAD 450
SARDIS AL
36775-3024
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-1649
  • Fax:
Mailing address:
  • Phone: 334-293-1649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: TAWANDA WILKINS
Title or Position: PHLEBOTOMY
Credential:
Phone: 334-293-1649