Provider Demographics
NPI:1659055887
Name:BEVEL UP MOBILE PHLEBOTOMY LLC
Entity Type:Organization
Organization Name:BEVEL UP MOBILE PHLEBOTOMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPT
Authorized Official - Prefix:MR
Authorized Official - First Name:MONDRAKUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-583-1477
Mailing Address - Street 1:12565 EVENING SHADE DR
Mailing Address - Street 2:
Mailing Address - City:BLACK JACK
Mailing Address - State:MO
Mailing Address - Zip Code:63033-8513
Mailing Address - Country:US
Mailing Address - Phone:314-583-1477
Mailing Address - Fax:314-216-3926
Practice Address - Street 1:12565 EVENING SHADE DR
Practice Address - Street 2:
Practice Address - City:BLACK JACK
Practice Address - State:MO
Practice Address - Zip Code:63033-8513
Practice Address - Country:US
Practice Address - Phone:314-583-1477
Practice Address - Fax:314-216-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health