Healthcare Provider Details

I. General information

NPI: 1780096180
Provider Name (Legal Business Name): EZ TUBZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 CRUMS LN
LOUISVILLE KY
40216-4253
US

IV. Provider business mailing address

2207 CRUMS LN
LOUISVILLE KY
40216-4253
US

V. Phone/Fax

Practice location:
  • Phone: 502-290-5248
  • Fax:
Mailing address:
  • Phone: 502-290-5248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSHON RENEE BLAKEY
Title or Position: OWNER
Credential: COUNSEL
Phone: 502-290-5248