Provider Demographics
NPI:1154862670
Name:BIO PHLEBOTOMY OF GREATER CLEVELAND
Entity Type:Organization
Organization Name:BIO PHLEBOTOMY OF GREATER CLEVELAND
Other - Org Name:THE BIO PHLEB GROUP LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MOBILE LAB MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAREBAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CPT
Authorized Official - Phone:216-400-9799
Mailing Address - Street 1:986 EVANGELINE RD
Mailing Address - Street 2:SUITE 2-3
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-3174
Mailing Address - Country:US
Mailing Address - Phone:216-400-9799
Mailing Address - Fax:
Practice Address - Street 1:574 E 200TH ST
Practice Address - Street 2:SUITE 2-3
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-1570
Practice Address - Country:US
Practice Address - Phone:216-400-9799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BIO PHLEB GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QH0100X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service