NPIMap

Organization Active NPI

Jack of All Stixx

  • Phlebotomy Technician
  • Greensboro, NC
National Provider Identifier
1700611563
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Phlebotomy TechnicianTaxonomy code 246RP1900X
Legal business name
JACK OF ALL STIXX
Practice address
2 Centerview Dr Ste 64
Greensboro, NC 27407-3708
Phone
(336) 303-0587
NPI assigned
Sep 3, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Authorized official

Name
Detavia KenanNPI 1073342325
Title
Owner
Phone
(336) 303-0587

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Phlebotomy Technician 246RP1900X Primary
In Home Supportive Care Agency 253Z00000X

Addresses

Primary practice location

2 Centerview Dr Ste 64
Greensboro, NC 27407-3708

Mailing address

555 Whistling Swan Dr
Greensboro, NC 27455-1535

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1725321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725321600000",
    "number": "1700611563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 WHISTLING SWAN DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274551535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 CENTERVIEW DR STE 64",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274073708",
            "telephone_number": "336-303-0587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK OF ALL STIXX",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-03",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A",
        "authorized_official_last_name": "KENAN",
        "authorized_official_first_name": "DETAVIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-303-0587"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; 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.