Provider Demographics
NPI:1104065705
Name:SOUTHEAST TEXAS PHLEBOTOMY INSTITUTE, INC.
Entity type:Organization
Organization Name:SOUTHEAST TEXAS PHLEBOTOMY INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:JOLIVET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-813-8471
Mailing Address - Street 1:2263 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-1552
Mailing Address - Country:US
Mailing Address - Phone:409-813-8471
Mailing Address - Fax:409-813-8471
Practice Address - Street 1:2263 NORTH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-1552
Practice Address - Country:US
Practice Address - Phone:409-813-8471
Practice Address - Fax:409-813-8471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory