NPIMap

Organization Active NPI

Fairy Wings Mobile Phlebotomy Service LLC

Doing business as Fairy Wings Laboratory and Specialty Services

  • Health Service Clinic/Center
  • Gulfport, MS
National Provider Identifier
1316517329
Registry record updated Apr 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
FAIRY WINGS MOBILE PHLEBOTOMY SERVICE LLC
Doing business as
Fairy Wings Laboratory and Specialty Services
Practice address
549 E Pass Rd Ste J
Gulfport, MS 39507-3261
Phone
(228) 284-5671
Fax
(228) 284-5724
NPI assigned
Jun 30, 2021
Last updated
Apr 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Tomieko Threadgill, PHLEBOT, NCMA, NCMLANPI 1972120525
Title
Owner
Phone
(228) 284-4176

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X NU Primary
Clinical Medical Laboratory 291U00000X NU
Durable Medical Equipment & Medical Supplies 332B00000X NU
Non-emergency Medical Transport (VAN) 343900000X NU
Private Vehicle 347C00000X NU

Addresses

Primary practice location

549 E Pass Rd Ste J
Gulfport, MS 39507-3261

Mailing address

549 E Pass Rd Ste J
Gulfport, MS 39507-3261
Phone (228) 284-4176

Other names 1

  • Fairy Wings Laboratory and Specialty Services Doing business as

National Provider Directory

National Provider Directory

Locations

549 E Pass Rd
Ste J
Gulfport, MS 39507
Phone (228) 284-4176

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681171200000",
    "number": "1316517329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "549 E PASS RD STE J",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395073261",
            "telephone_number": "228-284-4176",
            "fax_number": "228-284-5724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "549 E PASS RD STE J",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395073261",
            "telephone_number": "228-284-5671",
            "fax_number": "228-284-5724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRY WINGS MOBILE PHLEBOTOMY SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-30",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "THREADGILL",
        "authorized_official_first_name": "TOMIEKO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-284-4176",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHLEBOT, NCMA, NCMLA"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairy Wings Laboratory and Specialty Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.