MEDICARE: JAY B MOODY PHLEBOTOMY TECHNICIA

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	246RP1900X	OH
2	246RM2200X	Medical Laboratory Technician		OH
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1629519566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY B MOODY PHLEBOTOMY TECHNICIA

Provider Business Mailing Address
First Line	:	3605 CEDARBROOK RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3046
Country	:	US
Telephone Number	:	216-855-2658
Fax Number	:	216-284-2856

Provider Business Practice Location Address
First Line	:	3605 CEDARBROOK RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3046
Country	:	US
Telephone Number	:	216-855-2658
Fax Number	:	216-284-2856

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

Provider Enumeration Date	:	03/11/2017
Last Update Date	:	12/05/2025

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