MEDICARE: TEQUIDA C FARRISH PHLEBOTOMIST TECH

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	374U00000X	Home Health Aide		OH
2	246RP1900X	Phlebotomy Technician		OH

General Provider Information

NPI Number	:	1255293049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEQUIDA C FARRISH PHLEBOTOMIST TECH

Provider Business Mailing Address
First Line	:	3165 YORKSHIRE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2429
Country	:	US
Telephone Number	:	216-776-8832
Fax Number	:

Provider Business Practice Location Address
First Line	:	3165 YORKSHIRE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2429
Country	:	US
Telephone Number	:	216-776-8832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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