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General NPI Number Information
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NPI Number | 1699391300
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Entity Type | Organization
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Legal Business Name | JC MOBILE PHLEBOTOMY SERVICES, LLC
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 6047 BURGUNDY TER
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City | PORT ORANGE
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State | FL
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Zip | 32127-6785
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Country | US
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Telephone | 386-872-2581
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Fax | 386-961-4401
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Provider Business Mailing Address
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Address Line | PO BOX 290474
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City | PORT ORANGE
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State | FL
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Zip | 32129-0474
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Country | US
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Telephone | 386-872-2581
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Fax | 386-961-4401
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. JANET CHACE
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Credential | CERTIFIED PHLEBOTOMY
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Telephone | 386-872-2581
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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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