Provider Demographics
NPI:1053022509
Name:ENVEINA SERVICE CENTER LLC
Entity type:Organization
Organization Name:ENVEINA SERVICE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:KAWANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDUFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:CPI, CPT, AA
Authorized Official - Phone:919-638-5550
Mailing Address - Street 1:1308 BENT WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1969
Mailing Address - Country:US
Mailing Address - Phone:919-638-5550
Mailing Address - Fax:
Practice Address - Street 1:1405 OLD OXFORD RD STE F
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-8779
Practice Address - Country:US
Practice Address - Phone:919-638-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty