Provider Demographics
NPI:1396106159
Name:ROSE OF SHARON MOBILE PHLEBOTOMY SERVICES
Entity type:Organization
Organization Name:ROSE OF SHARON MOBILE PHLEBOTOMY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPT/ OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MALLORY
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:704-309-3912
Mailing Address - Street 1:305 FOXHALL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8820
Mailing Address - Country:US
Mailing Address - Phone:704-309-3912
Mailing Address - Fax:252-972-0425
Practice Address - Street 1:305 FOXHALL DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8820
Practice Address - Country:US
Practice Address - Phone:704-309-3912
Practice Address - Fax:252-972-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health