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Fairy Wings Mobile Phlebotomy Service, LLC

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Company Details

Name: Fairy Wings Mobile Phlebotomy Service, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 31 Dec 2019 (6 years ago)
Business ID: 1193271
ZIP code: 39503
County: Harrison
State of Incorporation: MISSISSIPPI
Principal Office Address: 13873 Lorado DrGulfport , MS 39503
Fictitious names: Fairy Wings Laboratory and Specialty Services
Historical names: Fairy Wings Mobile Phleobotomy Service, LLC

Agent

Name Role Address
Rita M Threadgill Agent 1220 East Cotton Drive, Greenville, MS 38701

Manager

Name Role Address
Tomieko L Threadgill Manager 13873 Lorado Drive, Apt 178, Gulfport, MS 39503

Other

Name Role Address
Tomieko L Threadgill Other 13873 Lorado Drive, Apt 178, Gulfport, MS 39503

President

Name Role Address
Tomieko L Threadgill President 13873 Lorado Drive, Apt 178, Gulfport, MS 39503

U.S. Small Business Administration Profile

Phone Number:
Fax Number:
228-284-5724
Contact Person:
TOMIEKO THREADGILL
Ownership and Self-Certifications:
Black American, Other Minority Owned, Economically Disadvantaged Women-Owned Small Business, Women-Owned Small Business, Woman Owned
User ID:
P2640873

Unique Entity ID

Unique Entity ID:
KHSRLJBQKCM9
CAGE Code:
969U9
UEI Expiration Date:
2025-12-18

Business Information

Activation Date:
2024-12-20
Initial Registration Date:
2021-07-28

National Provider Identifier

NPI Number:
1316517329
Certification Date:
2023-04-11

Authorized Person:

Name:
MS. TOMIEKO THREADGILL
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
291U00000X - Clinical Medical Laboratory
Is Primary:
No
Selected Taxonomy:
332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary:
No
Selected Taxonomy:
343900000X - Non-emergency Medical Transport (VAN)
Is Primary:
No
Selected Taxonomy:
347C00000X - Private Vehicle
Is Primary:
No
Selected Taxonomy:
261QH0100X - Health Service Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2282845724

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2025-04-11 Annual Report For Fairy Wings Mobile Phlebotomy Service, LLC
Annual Report LLC Filed 2024-01-25 Annual Report For Fairy Wings Mobile Phlebotomy Service, LLC
Fictitious Name Registration Filed 2023-03-06 Fictitious Name Registration For Fairy Wings Mobile Phlebotomy Service, LLC
Annual Report LLC Filed 2023-02-13 Annual Report For Fairy Wings Mobile Phlebotomy Service, LLC
Annual Report LLC Filed 2022-02-11 Annual Report For Fairy Wings Mobile Phlebotomy Service, LLC
Annual Report LLC Filed 2021-04-14 Annual Report For Fairy Wings Mobile Phlebotomy Service, LLC
Annual Report LLC Filed 2020-03-16 Annual Report For Fairy Wings Mobile Phlebotomy Service, LLC
Amendment Form Filed 2020-03-03 Amendment For Fairy Wings Mobile Phleobotomy Service, LLC
Amendment Form Filed 2019-12-20 Amendment For Fairy Wings Mobile Phleobotomy Service, LLC
Formation Form Filed 2019-11-08 Formation For Fairy Wings Mobile Phleobotomy Service, LLC

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Date of last update: 07 Jul 2025

Sources: Company Profile on Mississippi Secretary of State Website