MEDICARE: MARGORIE EDITH ALLDREDGE

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	20-00041156	AZ

General Provider Information

NPI Number	:	1598385825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGORIE EDITH ALLDREDGE

Provider Business Mailing Address
First Line	:	1940 MESQUITE AVE STE P
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6123
Country	:	US
Telephone Number	:	928-486-3989
Fax Number	:	928-453-2252

Provider Business Practice Location Address
First Line	:	1940 MESQUITE AVE STE P
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6123
Country	:	US
Telephone Number	:	928-486-3989
Fax Number	:

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

Provider Enumeration Date	:	04/16/2020
Last Update Date	:	04/16/2020

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