Healthcare Provider Details

I. General information

NPI: 1851170609
Provider Name (Legal Business Name): THE MOBILE PHLEBOTOMIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MANHATTAN BLVD BLDG D #3622
HARVEY LA
70058-3583
US

IV. Provider business mailing address

220 MEGAN LN
SLIDELL LA
70458-6002
US

V. Phone/Fax

Practice location:
  • Phone: 504-901-1017
  • Fax:
Mailing address:
  • Phone: 504-261-3981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: TEAREA BERNARD
Title or Position: MANAGER
Credential:
Phone: 504-261-3981