MEDICARE: THAT'S SO VEIN

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	:	1396491064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THAT'S SO VEIN

Provider Business Mailing Address
First Line	:	3425 BAYSIDE LAKES BLVD SE STE 103
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6867
Country	:	US
Telephone Number	:	321-730-2091
Fax Number	:	321-522-0114

Provider Business Practice Location Address
First Line	:	3425 BAYSIDE LAKES BLVD SE STE 103
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6867
Country	:	US
Telephone Number	:	321-730-2091
Fax Number	:	321-522-0114

Authorized Official
Title or Position	:	PHLEBOTOMIST
Name	:	TRICIA J DAWSON
Credential	:
Telephone Number	:	321-805-7021

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	02/22/2022

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Directions to “THAT'S SO VEIN ” Practice Location

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