Provider Demographics
NPI:1164170973
Name:DIVINE MOBILE PHLEBOTOMY SERVICES
Entity Type:Organization
Organization Name:DIVINE MOBILE PHLEBOTOMY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUFUS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:803-305-2177
Mailing Address - Street 1:2675 MAIDENHAIR LN
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-9521
Mailing Address - Country:US
Mailing Address - Phone:803-305-2177
Mailing Address - Fax:
Practice Address - Street 1:2675 MAIDENHAIR LN
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-9521
Practice Address - Country:US
Practice Address - Phone:803-305-2177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty