Provider Demographics
NPI:1760206429
Name:GOOD STICKS MOBILE PHLEBOTOMY LLC
Entity type:Organization
Organization Name:GOOD STICKS MOBILE PHLEBOTOMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:FELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-904-8260
Mailing Address - Street 1:17201 BLUE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-6460
Mailing Address - Country:US
Mailing Address - Phone:704-904-8260
Mailing Address - Fax:
Practice Address - Street 1:17201 BLUE SPRINGS DR
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-6460
Practice Address - Country:US
Practice Address - Phone:704-904-8260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty