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General NPI Number Information
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NPI Number | 1952736266
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Entity Type | Organization
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Legal Business Name | DIVINE TOUCH MOBILE PHLEBOTOMY SERVICE
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 6725 GROVERS AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19142-2608
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Country | US
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Telephone | 267-265-7240
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 33101
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City | PHILADELPHIA
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State | PA
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Zip | 19142-9998
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DENISE RANSOM
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Credential |
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Telephone | 267-265-7240
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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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