MEDICARE: PHLEBOTOMY INK ALLIED HEALTHCARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	261QH0100X	Health Service Clinic/Center
3	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1437771052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHLEBOTOMY INK ALLIED HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1100 E PARK DR STE 102
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-2563
Country	:	US
Telephone Number	:	205-582-9075
Fax Number	:	205-582-9079

Provider Business Practice Location Address
First Line	:	1100 E PARK DR STE 102
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-2563
Country	:	US
Telephone Number	:	205-582-9075
Fax Number	:	205-582-9079

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LAKIYA JONES
Credential	:
Telephone Number	:	205-582-9075

Provider Enumeration Date	:	05/18/2020
Last Update Date	:	11/22/2021

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