Provider Demographics
NPI:1710647847
Name:AT YOUR SIDE MOBILE PHLEBOTOMY LLC
Entity Type:Organization
Organization Name:AT YOUR SIDE MOBILE PHLEBOTOMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MOBILE PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:TYSHERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-401-7036
Mailing Address - Street 1:545 ASHMEAD RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1504
Mailing Address - Country:US
Mailing Address - Phone:267-401-7036
Mailing Address - Fax:
Practice Address - Street 1:545 ASHMEAD RD
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012-1504
Practice Address - Country:US
Practice Address - Phone:267-401-7036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty