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General NPI Number Information
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NPI Number | 1154862670
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Entity Type | Organization
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Legal Business Name | BIO PHLEBOTOMY OF GREATER CLEVELAND
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 574 E 200TH ST SUITE 2-3
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City | CLEVELAND
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State | OH
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Zip | 44119-1570
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Country | US
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Telephone | 216-400-9799
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Fax |
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Provider Business Mailing Address
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Address Line | 986 EVANGELINE RD SUITE 2-3
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City | CLEVELAND
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State | OH
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Zip | 44110-3174
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Country | US
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Telephone | 216-400-9799
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Fax |
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Authorized Official
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Title or Position | MOBILE LAB MANAGER
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Name | MRS. SHAREBAH WALKER
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Credential | MA, CPT
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Telephone | 216-400-9799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | OH
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