Provider Demographics
NPI:1205431848
Name:LABONE MOBILE PHLEBOTOMY INC
Entity type:Organization
Organization Name:LABONE MOBILE PHLEBOTOMY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KHAWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMIST
Authorized Official - Phone:219-302-4331
Mailing Address - Street 1:4701 E 13TH PL
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-3733
Mailing Address - Country:US
Mailing Address - Phone:219-302-4331
Mailing Address - Fax:219-888-9880
Practice Address - Street 1:4701 E 13TH PL
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-3733
Practice Address - Country:US
Practice Address - Phone:219-302-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty