1447941539 NPI number — ONE CALL WE DRAW MOBILE PHLEBOTOMY SERVICES, LLC

Table of content: ROBERT REID FULLER MSW, LCSW (NPI 1619223039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447941539 NPI number — ONE CALL WE DRAW MOBILE PHLEBOTOMY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE CALL WE DRAW MOBILE PHLEBOTOMY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447941539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 BALCONES DR STE 4000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-5417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-318-2199
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1735 ALAMO XING
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75701-6835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-920-6922
Provider Business Practice Location Address Fax Number:
903-582-6899
Provider Enumeration Date:
05/18/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MALONE
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
MOBILE PHLEBOTOMY
Authorized Official Telephone Number:
903-920-6922

Provider Taxonomy Codes

  • Taxonomy code: 246RP1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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