Provider Demographics
NPI:1912617747
Name:PHLEBOTOMIST ON WHEELS
Entity Type:Organization
Organization Name:PHLEBOTOMIST ON WHEELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-887-3900
Mailing Address - Street 1:1715 LANSING COVE DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-6017
Mailing Address - Country:US
Mailing Address - Phone:512-887-3900
Mailing Address - Fax:512-887-3909
Practice Address - Street 1:3810 MEDICAL PKWY STE 221
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4014
Practice Address - Country:US
Practice Address - Phone:512-887-3900
Practice Address - Fax:512-887-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty