Provider Demographics
NPI:1093403321
Name:ROSS MOBILE PHLEBOTOMY SERVICES, LLC
Entity type:Organization
Organization Name:ROSS MOBILE PHLEBOTOMY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PBT-ASCP
Authorized Official - Phone:920-340-8058
Mailing Address - Street 1:2300 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-1900
Mailing Address - Country:US
Mailing Address - Phone:920-340-8058
Mailing Address - Fax:920-340-8059
Practice Address - Street 1:1901 RIDGEWAY DR APT 6
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-3690
Practice Address - Country:US
Practice Address - Phone:920-301-9022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty