Provider Demographics
NPI:1053861518
Name:PRESTIGE PHLEBOTOMY
Entity Type:Organization
Organization Name:PRESTIGE PHLEBOTOMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLPHENEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-275-0901
Mailing Address - Street 1:17630 30TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98446-1113
Mailing Address - Country:US
Mailing Address - Phone:253-275-0901
Mailing Address - Fax:253-203-1671
Practice Address - Street 1:17630 30TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98446-1113
Practice Address - Country:US
Practice Address - Phone:253-275-0901
Practice Address - Fax:253-203-1671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-09
Last Update Date:2016-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603596285305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service