Provider Demographics
NPI:1558115725
Name:JD MOBILE PHLEBOTOMY LLC
Entity Type:Organization
Organization Name:JD MOBILE PHLEBOTOMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:267-545-8573
Mailing Address - Street 1:426 E ALLEGHENY AVE UNIT 315
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-2343
Mailing Address - Country:US
Mailing Address - Phone:267-545-8573
Mailing Address - Fax:
Practice Address - Street 1:426 E ALLEGHENY AVE UNIT 315
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19134-2343
Practice Address - Country:US
Practice Address - Phone:267-545-8573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory