Provider Demographics
NPI:1396341061
Name:SHELTON PROFESSIONAL PHLEBOTOMY SERVICES LLC
Entity type:Organization
Organization Name:SHELTON PROFESSIONAL PHLEBOTOMY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WELZIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEB
Authorized Official - Phone:313-953-8768
Mailing Address - Street 1:1311 S STEPHENSON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-4159
Mailing Address - Country:US
Mailing Address - Phone:906-239-6830
Mailing Address - Fax:
Practice Address - Street 1:201 RUBLEIN ST STE C
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4060
Practice Address - Country:US
Practice Address - Phone:313-953-8768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service