Provider Demographics
NPI:1407319395
Name:MOBILE PHLEBOTOMY OF CENTRAL MICHIGAN
Entity type:Organization
Organization Name:MOBILE PHLEBOTOMY OF CENTRAL MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BREASBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-715-2050
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:MI
Mailing Address - Zip Code:48637-0014
Mailing Address - Country:US
Mailing Address - Phone:989-715-2050
Mailing Address - Fax:
Practice Address - Street 1:22040 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:MI
Practice Address - Zip Code:48637-8707
Practice Address - Country:US
Practice Address - Phone:989-715-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty