MEDICARE: SACRED HEART PHLEBOTOMY LLC

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	:	1952185860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED HEART PHLEBOTOMY LLC

Provider Business Mailing Address
First Line	:	6745 W 63RD ST STE 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-4003
Country	:	US
Telephone Number	:	773-815-5573
Fax Number	:

Provider Business Practice Location Address
First Line	:	6745 W 63RD ST STE 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-4003
Country	:	US
Telephone Number	:	773-815-5573
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHARI FLAGG
Credential	:
Telephone Number	:	773-815-5573

Provider Enumeration Date	:	08/22/2023
Last Update Date	:	08/22/2023

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