Healthcare Provider Details

I. General information

NPI: 1164394375
Provider Name (Legal Business Name): PURPLE HEART MOBILE PHLEBOTOMY & LABORATORY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 TUCKER LN APT B1
BALTIMORE MD
21207-7839
US

IV. Provider business mailing address

2204 TUCKER LN APT B1
BALTIMORE MD
21207-7839
US

V. Phone/Fax

Practice location:
  • Phone: 804-940-9171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number State

VIII. Authorized Official

Name: LATRESCIA REEVES
Title or Position: OWNER
Credential: SOLE MBR
Phone: 804-940-9171