Provider Demographics
NPI:1013453323
Name:PHLEBOTOMY TO GO, LLC
Entity Type:Organization
Organization Name:PHLEBOTOMY TO GO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:EMT1-A, CPT1, EKG
Authorized Official - Phone:520-314-8057
Mailing Address - Street 1:2 S 35TH AVE UNIT 18678
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-4772
Mailing Address - Country:US
Mailing Address - Phone:520-314-8057
Mailing Address - Fax:800-224-0206
Practice Address - Street 1:2 S 35TH AVE UNIT 18678
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-4772
Practice Address - Country:US
Practice Address - Phone:520-314-8057
Practice Address - Fax:800-224-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory