MEDICARE: PHLEBLAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1023721750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHLEBLAB LLC

Provider Business Mailing Address
First Line	:	1536 SAINT CLAIR AVE NE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	464 RICHMOND RD
Second Line	:
City	:	RICHMOND HTS
State	:	OH
Zip	:	44143-2792
Country	:	US
Telephone Number	:	216-832-6764
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. RENEE DENISE BLACKMON
Credential	:	CEO
Telephone Number	:	216-832-6764

Provider Enumeration Date	:	12/27/2022
Last Update Date	:	12/27/2022

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Directions to “PHLEBLAB LLC ” Practice Location

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