Provider Demographics
NPI:1871036269
Name:CONVENIENT CARE MOBILE PHLEBOTOMY LAB
Entity Type:Organization
Organization Name:CONVENIENT CARE MOBILE PHLEBOTOMY LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SALICE
Authorized Official - Middle Name:BERLIN
Authorized Official - Last Name:HARTFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMIST
Authorized Official - Phone:216-931-6222
Mailing Address - Street 1:13381 WOLF AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-3766
Mailing Address - Country:US
Mailing Address - Phone:216-931-6222
Mailing Address - Fax:
Practice Address - Street 1:13381 WOLF AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3766
Practice Address - Country:US
Practice Address - Phone:216-931-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty