Provider Demographics
NPI:1124805981
Name:GLORIA'S PHLEBOTOMY SERVICE
Entity type:Organization
Organization Name:GLORIA'S PHLEBOTOMY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAURTHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-336-3669
Mailing Address - Street 1:408 W HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2927
Mailing Address - Country:US
Mailing Address - Phone:662-336-3669
Mailing Address - Fax:
Practice Address - Street 1:408 W HARDING AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2927
Practice Address - Country:US
Practice Address - Phone:662-336-3669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory