Provider Demographics
NPI:1164140976
Name:MOE'S PHLEBOTOMY SERVICE'S
Entity Type:Organization
Organization Name:MOE'S PHLEBOTOMY SERVICE'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMIST
Authorized Official - Phone:985-517-8291
Mailing Address - Street 1:1585 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-6620
Mailing Address - Country:US
Mailing Address - Phone:985-517-8291
Mailing Address - Fax:
Practice Address - Street 1:1585 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-6620
Practice Address - Country:US
Practice Address - Phone:985-517-8291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty