Provider Demographics
NPI:1558071993
Name:EXQUISITE MOBILE PHLEBOTOMY CORP
Entity Type:Organization
Organization Name:EXQUISITE MOBILE PHLEBOTOMY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-227-6111
Mailing Address - Street 1:458 BRENTWOOD DR APT 6
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4832
Mailing Address - Country:US
Mailing Address - Phone:863-227-6111
Mailing Address - Fax:
Practice Address - Street 1:458 BRENTWOOD DR APT 6
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4832
Practice Address - Country:US
Practice Address - Phone:863-227-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center