Provider Demographics
NPI:1437702867
Name:EXCELLENT PHLEBOTOMY LAB SERVICES LLC
Entity Type:Organization
Organization Name:EXCELLENT PHLEBOTOMY LAB SERVICES LLC
Other - Org Name:EP LAB SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATRILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-748-0207
Mailing Address - Street 1:1615 OSPREY DR STE 107
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2427
Mailing Address - Country:US
Mailing Address - Phone:469-930-5842
Mailing Address - Fax:866-315-5210
Practice Address - Street 1:1615 OSPREY DR STE 107
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2427
Practice Address - Country:US
Practice Address - Phone:469-930-5842
Practice Address - Fax:866-315-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty