Healthcare Provider Details

I. General information

NPI: 1386228294
Provider Name (Legal Business Name): MASSEY MOBILE PHLEBOTOMY SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 PLYMOUTH AVE STE 110
SAINT LOUIS MO
63133-1940
US

IV. Provider business mailing address

833 ELSWORTH PL
FERGUSON MO
63135-3127
US

V. Phone/Fax

Practice location:
  • Phone: 314-281-9482
  • Fax: 314-300-4055
Mailing address:
  • Phone: 314-250-7206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: SABERRA MASSEY-HILL
Title or Position: OWNER
Credential:
Phone: 314-281-9482