Provider Demographics
NPI:1245763838
Name:KIND HEART PHLEBOTOMY
Entity Type:Organization
Organization Name:KIND HEART PHLEBOTOMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYSHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDUFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMIST
Authorized Official - Phone:219-776-0883
Mailing Address - Street 1:PO BOX 11226
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411
Mailing Address - Country:US
Mailing Address - Phone:121-988-8981
Mailing Address - Fax:
Practice Address - Street 1:1100 E 56TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1726
Practice Address - Country:US
Practice Address - Phone:121-947-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory