Provider Demographics
NPI:1346835824
Name:VENISTAT MOBILE PHLEBOTOMY LLC
Entity Type:Organization
Organization Name:VENISTAT MOBILE PHLEBOTOMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:937-307-9639
Mailing Address - Street 1:221 OUTER BELLE RD APT A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1538
Mailing Address - Country:US
Mailing Address - Phone:937-307-9639
Mailing Address - Fax:937-715-4049
Practice Address - Street 1:221 OUTER BELLE RD APT A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-1538
Practice Address - Country:US
Practice Address - Phone:937-307-9639
Practice Address - Fax:937-715-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory