Healthcare Provider Details

I. General information

NPI: 1013554807
Provider Name (Legal Business Name): WILLIA B TUBBS CCMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2019
Last Update Date: 05/22/2023
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 WESLEYAN RD # 207
INDIANAPOLIS IN
46268-3110
US

IV. Provider business mailing address

9030 WESLEYAN RD # 207
INDIANAPOLIS IN
46268-3110
US

V. Phone/Fax

Practice location:
  • Phone: 260-217-3187
  • Fax:
Mailing address:
  • Phone: 260-217-3187
  • 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:
Title or Position:
Credential:
Phone: