Provider Demographics
NPI:1184157935
Name:HOOPER'S MOBILE PHLEBOTOMIST
Entity type:Organization
Organization Name:HOOPER'S MOBILE PHLEBOTOMIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-402-5932
Mailing Address - Street 1:PO BOX 14781
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4781
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 FRIENDWAY RD APT 3L
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6403
Practice Address - Country:US
Practice Address - Phone:336-402-5932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-08
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X, 251J00000X, 261QA0600X, 291900000X, 291U00000X, 292200000X, 293D00000X, 320800000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No291900000XLaboratoriesMilitary Clinical Medical Laboratory
No291U00000XLaboratoriesClinical Medical Laboratory
No292200000XLaboratoriesDental Laboratory
No293D00000XLaboratoriesPhysiological Laboratory
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness