MEDICARE: PATERNITY GENETICS DNA MOBILE SERVICE

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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1104707884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATERNITY GENETICS DNA MOBILE SERVICE

Provider Business Mailing Address
First Line	:	11813 KENSINGTON AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5200
Country	:	US
Telephone Number	:	440-688-1692
Fax Number	:

Provider Business Practice Location Address
First Line	:	11813 KENSINGTON AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5200
Country	:	US
Telephone Number	:	440-688-1692
Fax Number	:

Authorized Official
Title or Position	:	PHLEBOTOMIST
Name	:	MISS ADRIA E CALDWELL
Credential	:	PHLEBOTOMY CERTIFIED
Telephone Number	:	440-688-1692

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	01/27/2026

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