Healthcare Provider Details

I. General information

NPI: 1285230987
Provider Name (Legal Business Name): HEMO-STAT PHLEBOTOMY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14721 BEACHVIEW TERRECE
DOLTON IL
60419
US

IV. Provider business mailing address

14721 BEACHVIEW TERRECE
DOLTON IL
60419
US

V. Phone/Fax

Practice location:
  • Phone: 708-573-1665
  • Fax: 708-996-0074
Mailing address:
  • Phone: 708-516-6243
  • 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: LAKESA JEAN LEE
Title or Position: PHLEBOTOMIST
Credential:
Phone: 708-516-6243