Provider Demographics
NPI:1659965887
Name:STAT MOBILE PHLEBOTOMY LLC
Entity Type:Organization
Organization Name:STAT MOBILE PHLEBOTOMY LLC
Other - Org Name:STAT MOBILE PHLEBOTOMY AND LABORATORY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:HEATHERKAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:312-508-0530
Mailing Address - Street 1:3202 7TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60085-6985
Mailing Address - Country:US
Mailing Address - Phone:872-813-4712
Mailing Address - Fax:872-813-5255
Practice Address - Street 1:1700 N BERWICK BLVD APT K212
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-1578
Practice Address - Country:US
Practice Address - Phone:312-508-0530
Practice Address - Fax:872-813-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-28
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty