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General NPI Number Information
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NPI Number | 1356120836
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Entity Type | Organization
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Legal Business Name | MOBILE PHLEBOTOMY EXCELLENCE
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 109 E VIOLA ST
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City | AVON PARK
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State | FL
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Zip | 33825-2249
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Country | US
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Telephone | 888-919-2509
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Fax | 863-900-9720
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Provider Business Mailing Address
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Address Line | PO BOX 7090
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City | AVON PARK
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State | FL
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Zip | 33826-7090
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Country | US
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Telephone | 888-919-2509
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Fax | 863-900-9720
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Authorized Official
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Title or Position | ASCP-PBT
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Name | MS. TIFFANY LASHAE BROWN
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Credential |
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Telephone | 863-275-4405
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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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