Provider Demographics
NPI:1205468204
Name:INDEPENDENT PHLEBOTOMY SERVICES LLC
Entity type:Organization
Organization Name:INDEPENDENT PHLEBOTOMY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROBINETTE
Authorized Official - Suffix:
Authorized Official - Credentials:CPT1/MA
Authorized Official - Phone:234-521-0651
Mailing Address - Street 1:PO BOX 8545
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44711-8545
Mailing Address - Country:US
Mailing Address - Phone:234-521-0651
Mailing Address - Fax:
Practice Address - Street 1:504 25TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3824
Practice Address - Country:US
Practice Address - Phone:234-521-0651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty