Organization
FAIRY WINGS MOBILE PHLEBOTOMY SERVICE LLC
Active
Other names
Fairy Wings Laboratory and Specialty Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TOMIEKO THREADGILL PHLEBOT, NCMA, NCMLA (OWNER)
(228) 284-4176
Entity
Organization
Contact information
Practice address
549 E PASS RD STE J, GULFPORT, MS 39507-3261
(228) 284-5671
(228) 284-5724
Mailing address
549 E PASS RD STE J, GULFPORT, MS 39507-3261
(228) 284-4176
(228) 284-5724
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
06/30/2021
Last updated
04/11/2023
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