Provider Demographics
NPI:1225547771
Name:1 SHOT PHLEBOTOMY LLC
Entity Type:Organization
Organization Name:1 SHOT PHLEBOTOMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHLEBOTOMIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PBT (ASCP)
Authorized Official - Phone:440-310-4561
Mailing Address - Street 1:14637 REVERE CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7044
Mailing Address - Country:US
Mailing Address - Phone:440-310-4561
Mailing Address - Fax:
Practice Address - Street 1:14637 REVERE CIR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7044
Practice Address - Country:US
Practice Address - Phone:440-310-4561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty