Provider Demographics
NPI:1760936900
Name:COASTAL MOBILE PHLEBOTOMY
Entity Type:Organization
Organization Name:COASTAL MOBILE PHLEBOTOMY
Other - Org Name:COASTAL PHLEBOTOMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CMA/CPT
Authorized Official - Phone:207-542-9826
Mailing Address - Street 1:45 CHILDS ST
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04681-3514
Mailing Address - Country:US
Mailing Address - Phone:207-542-9826
Mailing Address - Fax:207-942-5663
Practice Address - Street 1:45 CHILDS ST
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:ME
Practice Address - Zip Code:04681-3514
Practice Address - Country:US
Practice Address - Phone:207-542-9826
Practice Address - Fax:207-942-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME8765180171W00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE8E4J6X7OtherNHA
MEY2S2Y4Z6OtherNHA