Provider Demographics
NPI:1083912778
Name:K&A PHLEBOTOMY SERVICE
Entity Type:Organization
Organization Name:K&A PHLEBOTOMY SERVICE
Other - Org Name:K&A PHLEBOTOMY SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-565-9370
Mailing Address - Street 1:190 NE 199 ST
Mailing Address - Street 2:STE 201
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179
Mailing Address - Country:US
Mailing Address - Phone:786-269-2388
Mailing Address - Fax:786-565-9914
Practice Address - Street 1:1224 SW 71TH TERRACE
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-5584
Practice Address - Country:US
Practice Address - Phone:954-369-7253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory