Provider Demographics
NPI:1548816135
Name:VENOTECH PHLEBOTOMY
Entity type:Organization
Organization Name:VENOTECH PHLEBOTOMY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STOVALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-645-9829
Mailing Address - Street 1:23330 OAK GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3491
Mailing Address - Country:US
Mailing Address - Phone:800-645-9829
Mailing Address - Fax:
Practice Address - Street 1:23330 OAK GLEN DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3491
Practice Address - Country:US
Practice Address - Phone:800-645-9829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITAL IMAGE PHLEBOTOMY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-11
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty