Provider Demographics
NPI:1861037699
Name:CONCIERGE PROFESSIONAL PHLEBOTOMY SERVICE, LLC
Entity Type:Organization
Organization Name:CONCIERGE PROFESSIONAL PHLEBOTOMY SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MLS, MSHA
Authorized Official - Phone:901-218-6769
Mailing Address - Street 1:6281 FISKE RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-1107
Mailing Address - Country:US
Mailing Address - Phone:901-218-6769
Mailing Address - Fax:
Practice Address - Street 1:2670 UNION AVENUE EXT STE 1216
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4422
Practice Address - Country:US
Practice Address - Phone:901-218-6769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty