Provider Demographics
NPI:1578188439
Name:INTEGRITY MOBILE PHLEBOTOMY SERVICES
Entity Type:Organization
Organization Name:INTEGRITY MOBILE PHLEBOTOMY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUANTACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-202-8531
Mailing Address - Street 1:613 BRIDGEWOOD CIR APT 524
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-1729
Mailing Address - Country:US
Mailing Address - Phone:682-202-8531
Mailing Address - Fax:817-507-3102
Practice Address - Street 1:613 BRIDGEWOOD CIR APT 524
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-1729
Practice Address - Country:US
Practice Address - Phone:682-202-8531
Practice Address - Fax:817-507-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory