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General NPI Number Information
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NPI Number | 1245763838
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Entity Type | Organization
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Legal Business Name | KIND HEART PHLEBOTOMY
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 1100 E 56TH AVE
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City | MERRILLVILLE
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State | IN
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Zip | 46410-1726
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Country | US
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Telephone | 121-947-2227
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11226
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City | MERRILLVILLE
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State | IN
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Zip | 46411
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Country | US
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Telephone | 121-988-8981
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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 | TYSHARON MCDUFFIE
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Credential | PHLEBOTOMIST
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Telephone | 219-776-0883
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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 | IN
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