Provider Demographics
NPI:1649060757
Name:LEGENDARY MOBILE PHLEBOTOMY & LAB LLC
Entity type:Organization
Organization Name:LEGENDARY MOBILE PHLEBOTOMY & LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-632-3104
Mailing Address - Street 1:8317 WEST MOHAVE STREET
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-8959
Mailing Address - Country:US
Mailing Address - Phone:602-632-3104
Mailing Address - Fax:
Practice Address - Street 1:8317 WEST MOHAVE STREET
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-8959
Practice Address - Country:US
Practice Address - Phone:602-632-3104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty