MEDICARE: THE PHLEBOTOTMY INSTITUTE MOBILE

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	:	1811706740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PHLEBOTOTMY INSTITUTE MOBILE

Provider Business Mailing Address
First Line	:	2290 W OREGON AVE # 1141
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4197
Country	:	US
Telephone Number	:	520-729-2707
Fax Number	:	445-800-8643

Provider Business Practice Location Address
First Line	:	709 N 2ND STREET
Second Line	:	SUITE 400 #1241
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-4197
Country	:	US
Telephone Number	:	520-729-2707
Fax Number	:	445-800-8643

Authorized Official
Title or Position	:	OWNER
Name	:	TYISHA CHARLES
Credential	:
Telephone Number	:	520-729-2707

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	02/03/2025

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