FAIRY WINGS MOBILE PHLEBOTOMY SERVICE LLC NPI 1316517329

NPI Information

NPI: 1316517329
Provider Name: FAIRY WINGS MOBILE PHLEBOTOMY SERVICE LLC

Doing Business As: FAIRY WINGS LABORATORY AND SPECIALTY SERVICES

Classification: Clinic/Center - 261QH0100X
Entity Type: Organization

Specialization: Health Service

Address:
549 E PASS RD STE J
GULFPORT, MS
ZIP 39507
Phone: (228) 284-5671
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FAIRY WINGS MOBILE PHLEBOTOMY SERVICE LLC is a health service clinic center in Gulfport, MS. FAIRY WINGS MOBILE PHLEBOTOMY SERVICE LLC NPI is 1316517329. The provider is registered as an organization entity type.
The provider Is Doing Business As Fairy Wings Laboratory And Specialty Services.

The provider's business location address is:

549 E PASS RD STE J
GULFPORT, MS
ZIP 39507-261
Phone: (228) 284-5671
Fax: (228) 284-5724

The provider's authorized official is Tomieko Threadgill .
The authorized official title is Owner and has the following contact phone number (228) 284-4176.

The CLIA number assigned to this NPI record is 25D2232943 - mobile laboratory with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/30/2021 and was last updated on 4/11/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	291U00000X	Clinical Medical Laboratory		No
2	332B00000X	Durable Medical Equipment & Medical Supplies		No
3	343900000X	Non-emergency Medical Transport (VAN)		No
4	347C00000X	Private Vehicle		No
5	261QH0100X	Clinic/Center	Health Service	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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