Healthcare Provider Details

I. General information

NPI: 1043736911
Provider Name (Legal Business Name): 1ST. STICK MEDICAL DRAW STATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 WESTOVER HILLS BLVD STE 1A
RICHMOND VA
23225-3153
US

IV. Provider business mailing address

4331 BATHGATE RD
RICHMOND VA
23234-3581
US

V. Phone/Fax

Practice location:
  • Phone: 804-424-3260
  • Fax: 804-424-3261
Mailing address:
  • Phone: 804-549-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number246RP1900X
License Number StateVA

VIII. Authorized Official

Name: TELLY LESHAN OWENS
Title or Position: CEO
Credential:
Phone: 804-424-3260