Healthcare Provider Details

I. General information

NPI: 1760206429
Provider Name (Legal Business Name): GOOD STICKS MOBILE PHLEBOTOMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17201 BLUE SPRINGS DR
KANNAPOLIS NC
28081-6460
US

IV. Provider business mailing address

17201 BLUE SPRINGS DR
KANNAPOLIS NC
28081-6460
US

V. Phone/Fax

Practice location:
  • Phone: 704-904-8260
  • Fax:
Mailing address:
  • Phone: 704-904-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY ALICE FELDER
Title or Position: LAB DIRECTOR
Credential:
Phone: 704-904-8260