Provider Demographics
NPI:1548829179
Name:INDEPENDENT PHLEBOTOMY SERVICES
Entity type:Organization
Organization Name:INDEPENDENT PHLEBOTOMY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:386-677-8338
Mailing Address - Street 1:977 GARDENIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4838
Mailing Address - Country:US
Mailing Address - Phone:386-677-8338
Mailing Address - Fax:386-673-5729
Practice Address - Street 1:977 GARDENIA DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4838
Practice Address - Country:US
Practice Address - Phone:386-677-8338
Practice Address - Fax:386-673-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty