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General NPI Number Information
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NPI Number | 1417640178
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Entity Type | Organization
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Legal Business Name | VENI-PHLEB ELITE LLC
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 3229 W 52ND ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46228-2114
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Country | US
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Telephone | 260-217-3187
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Fax |
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Provider Business Mailing Address
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Address Line | 3229 W 52ND ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46228-2114
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Country | US
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Telephone | 317-548-9074
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WILLIA B TUBBS
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Credential | CCMA
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Telephone | 260-217-3187
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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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