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General NPI Number Information
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NPI Number | 1194208769
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Entity Type | Organization
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Legal Business Name | CSA PHLEBOTOMY, LLC
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 1326 S MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-2253
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Country | US
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Telephone | 734-686-7839
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Fax |
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Provider Business Mailing Address
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Address Line | 1326 S MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-2253
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Country | US
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Telephone | 734-686-7839
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL LAB ASSOCIATE
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Name | CANDI STARR ALONG
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Credential |
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Telephone | 734-686-7839
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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 |
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License Number State |
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