Healthcare Provider Details

I. General information

NPI: 1801364849
Provider Name (Legal Business Name): ONSITE PHLEBOTOMY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 ORMWOOD DR
ORMOND BEACH FL
32176-4145
US

IV. Provider business mailing address

176 ORMWOOD DR
ORMOND BEACH FL
32176-4145
US

V. Phone/Fax

Practice location:
  • Phone: 386-238-9139
  • Fax:
Mailing address:
  • Phone: 386-238-9139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS DUBRULE
Title or Position: PRESIDENT
Credential:
Phone: 386-238-9139