Healthcare Provider Details

I. General information

NPI: 1982027884
Provider Name (Legal Business Name): FLYBOTOMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12680 W LAKE HOUSTON PKWY
HOUSTON TX
77044-6087
US

IV. Provider business mailing address

12680 W LAKE HOUSTON PKWY
HOUSTON TX
77044-6087
US

V. Phone/Fax

Practice location:
  • Phone: 832-356-8241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. CURRISSA PRUITT ALSOBROOKS
Title or Position: OWNER
Credential: MD
Phone: 832-356-8241