Provider Demographics
NPI:1356120836
Name:MOBILE PHLEBOTOMY EXCELLENCE
Entity type:Organization
Organization Name:MOBILE PHLEBOTOMY EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASCP-PBT
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:LASHAE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-275-4405
Mailing Address - Street 1:PO BOX 7090
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33826-7090
Mailing Address - Country:US
Mailing Address - Phone:888-919-2509
Mailing Address - Fax:863-900-9720
Practice Address - Street 1:109 E VIOLA ST
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2249
Practice Address - Country:US
Practice Address - Phone:888-919-2509
Practice Address - Fax:863-900-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory