Provider Demographics
NPI:1619660339
Name:PHLEBOTOTMY ON WHEELS
Entity Type:Organization
Organization Name:PHLEBOTOTMY ON WHEELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-464-0477
Mailing Address - Street 1:390 COUNTRY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-8317
Mailing Address - Country:US
Mailing Address - Phone:803-464-0477
Mailing Address - Fax:
Practice Address - Street 1:390 COUNTRY SPRINGS DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-8317
Practice Address - Country:US
Practice Address - Phone:803-464-0477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty