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General NPI Number Information
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NPI Number | 1669319497
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Entity Type | Organization
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Legal Business Name | ESSENTIAL LIFE DIAGNOSTICS
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Dates
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Enumeration Date | 04/30/2026
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Last Update Date | 04/30/2026
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Provider Practice Location Address
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Address Line | 7049 TAYLORSVILLE RD STE D2
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-3190
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Country | US
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Telephone | 937-251-6446
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Fax | 877-552-1617
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Provider Business Mailing Address
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Address Line | 711 CLEVERLY RD
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City | DAYTON
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State | OH
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Zip | 45417-1210
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Country | US
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Telephone | 937-301-9356
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Fax | 877-552-1617
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Authorized Official
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Title or Position | OWNER/CPT
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Name | MISS WILLENA MCCALLUM
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Credential | MCCALLUM
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Telephone | 937-251-6446
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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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