Provider Demographics
NPI:1245919042
Name:A GENTLE DRAW MOBILE PHLEBOTOMY
Entity type:Organization
Organization Name:A GENTLE DRAW MOBILE PHLEBOTOMY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORLISS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-814-5802
Mailing Address - Street 1:1054 OLD ROSEBUD DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-1208
Mailing Address - Country:US
Mailing Address - Phone:512-814-5802
Mailing Address - Fax:512-727-2136
Practice Address - Street 1:551 S. I-35 FRONTAGE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664
Practice Address - Country:US
Practice Address - Phone:512-814-5802
Practice Address - Fax:512-727-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory