=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962609123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHLEBOTOMISTS ON WHEELS,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2007
-----------------------------------------------------
Last Update Date | 03/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1451 W CYPRESS CREEK RD STE 300 ROOM 100
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33309-1961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-889-1226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1451 W CYPRESS CREEK RD STE 300 ROOM 100
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33309-1961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-889-1226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TAMIKA SHONTAL WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-682-1262
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------