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General NPI Number Information
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NPI Number | 1093093494
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Entity Type | Organization
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Legal Business Name | PHLEBOCARE MOBILE LLC
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 1203 US HIGHWAY 98 SUITE 2A-9
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City | DAPHNE
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State | AL
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Zip | 36526-4277
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Country | US
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Telephone | 251-401-8481
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Fax |
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Provider Business Mailing Address
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Address Line | 1203 US HIGHWAY 98 SUITE 2A-9
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City | DAPHNE
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State | AL
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Zip | 36526-4277
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Country | US
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Telephone | 251-401-8481
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Fax |
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Authorized Official
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Title or Position | FOUNDER CEO
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Name | MR. TYRONE WATSON
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Credential |
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Telephone | 251-401-8481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 2014-2728
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License Number State | AL
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