Provider Demographics
NPI:1194208769
Name:CSA PHLEBOTOMY, LLC
Entity Type:Organization
Organization Name:CSA PHLEBOTOMY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL LAB ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:CANDI
Authorized Official - Middle Name:STARR
Authorized Official - Last Name:ALONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-686-7839
Mailing Address - Street 1:1326 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2253
Mailing Address - Country:US
Mailing Address - Phone:734-686-7839
Mailing Address - Fax:
Practice Address - Street 1:1326 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2253
Practice Address - Country:US
Practice Address - Phone:734-686-7839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CSA PHLEBOTOMY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory