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General NPI Number Information
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NPI Number | 1225763782
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Entity Type | Organization
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Legal Business Name | KEE BODY BAR LLC
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 1506 BROADWAY ST STE 105
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City | PEARLAND
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State | TX
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Zip | 77581-5837
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Country | US
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Telephone | 832-901-1527
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Fax |
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Provider Business Mailing Address
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Address Line | 11427 SABO RD
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City | HOUSTON
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State | TX
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Zip | 77089-2501
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Country | US
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Telephone | 832-901-1527
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Fax |
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Authorized Official
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Title or Position | PHLEBOTOMIST/ OWNER
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Name | TAMARIA BACKMAN
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Credential |
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Telephone | 832-901-1527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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