MEDICARE: PHLEBOTOTMY ON WHEELS

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	:	1619660339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHLEBOTOTMY ON WHEELS

Provider Business Mailing Address
First Line	:	390 COUNTRY SPRINGS DR
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-8317
Country	:	US
Telephone Number	:	803-464-0477
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 COUNTRY SPRINGS DR
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-8317
Country	:	US
Telephone Number	:	803-464-0477
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAJA WATFORD
Credential	:
Telephone Number	:	803-464-0477

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	05/30/2023

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Directions to “PHLEBOTOTMY ON WHEELS ” Practice Location

Language	Start Address	Practice Location

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