MEDICARE: PRESTIGE PHLEBOTOMY, CORPORATION

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	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1295685097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE PHLEBOTOMY, CORPORATION

Provider Business Mailing Address
First Line	:	309 N GALLOWAY AVE STE 101
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-4300
Country	:	US
Telephone Number	:	469-619-7618
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 N GALLOWAY AVE STE 101
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-4300
Country	:	US
Telephone Number	:	469-619-7618
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	TOMORA DUNCAN
Credential	:	B.S.B.A., CPT
Telephone Number	:	469-618-7618

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/31/2026

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