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General NPI Number Information
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NPI Number | 1700275914
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Entity Type | Organization
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Legal Business Name | MOBILE PHLEBOTOMY SERVICE
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 7120 W 114TH ST
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City | WORTH
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State | IL
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Zip | 60482-2039
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Country | US
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Telephone | 708-577-3206
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Fax | 708-586-2221
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Provider Business Mailing Address
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Address Line | 7120 W 114TH ST
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City | WORTH
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State | IL
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Zip | 60482-2039
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Country | US
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Telephone | 708-577-3206
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. AMALIA J HOSKINS
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Credential | PTB
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Telephone | 708-577-3206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | PBT(ASCP)38989
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | PBT(ASCP)38989
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License Number State | IL
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