MEDICARE: GLORIA'S PHLEBOTOMY 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1124805981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORIA'S PHLEBOTOMY SERVICE

Provider Business Mailing Address
First Line	:	408 W HARDING AVE
Second Line	:
City	:	GREENWOOD
State	:	MS
Zip	:	38930-2927
Country	:	US
Telephone Number	:	662-336-3669
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 W HARDING AVE
Second Line	:
City	:	GREENWOOD
State	:	MS
Zip	:	38930-2927
Country	:	US
Telephone Number	:	662-336-3669
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS LAURTHER R ADAMS
Credential	:
Telephone Number	:	662-336-3669

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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