Provider Demographics
NPI:1700275914
Name:MOBILE PHLEBOTOMY SERVICE
Entity Type:Organization
Organization Name:MOBILE PHLEBOTOMY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMALIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOSKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PTB
Authorized Official - Phone:708-577-3206
Mailing Address - Street 1:7120 W 114TH ST
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-2039
Mailing Address - Country:US
Mailing Address - Phone:708-577-3206
Mailing Address - Fax:
Practice Address - Street 1:7120 W 114TH ST
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-2039
Practice Address - Country:US
Practice Address - Phone:708-577-3206
Practice Address - Fax:708-586-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPBT(ASCP)38989251E00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No251E00000XAgenciesHome Health