Healthcare Provider Details

I. General information

NPI: 1891582300
Provider Name (Legal Business Name): THE PHLEB COACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 LINDELL BLVD STE 209
SAINT LOUIS MO
63108-3254
US

IV. Provider business mailing address

3920 LINDELL BLVD STE 209
SAINT LOUIS MO
63108-3254
US

V. Phone/Fax

Practice location:
  • Phone: 314-932-7196
  • Fax:
Mailing address:
  • Phone: 314-932-7196
  • 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: MRS. SALIDA-MARIE JONES
Title or Position: MANAGING MEMBER
Credential: CPT, RMA
Phone: 314-422-1489