Provider Demographics
NPI:1174155931
Name:EMS PROFICIENT MOBILE PHLEBOTOMY SERVICE LLC
Entity type:Organization
Organization Name:EMS PROFICIENT MOBILE PHLEBOTOMY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:813-369-4249
Mailing Address - Street 1:P.O. BOX 6472
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33583-6472
Mailing Address - Country:US
Mailing Address - Phone:813-369-4249
Mailing Address - Fax:888-831-5133
Practice Address - Street 1:7402 NORTH 56TH STREET
Practice Address - Street 2:SUITE 710
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-3361
Practice Address - Country:US
Practice Address - Phone:813-769-9235
Practice Address - Fax:888-831-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory