Provider Demographics
NPI:1053947838
Name:ALLIMAC MOBILE PHLEBOTOMY LAB
Entity type:Organization
Organization Name:ALLIMAC MOBILE PHLEBOTOMY LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMY/LAB ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-516-5988
Mailing Address - Street 1:PO BOX 23336
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70183-0336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 SIZELER AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-1714
Practice Address - Country:US
Practice Address - Phone:504-516-5988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory