Healthcare Provider Details

I. General information

NPI: 1588662084
Provider Name (Legal Business Name): BLOODWORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 TERRY AVE
SEATTLE WA
98104-1239
US

IV. Provider business mailing address

921 TERRY AVE
SEATTLE WA
98104-1239
US

V. Phone/Fax

Practice location:
  • Phone: 206-292-6500
  • Fax: 206-689-8365
Mailing address:
  • Phone: 206-292-6500
  • Fax: 206-689-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberFX00004065
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code331L00000X
TaxonomyBlood Bank
License Number
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHWH.FX.60073065
License Number StateWA

VIII. Authorized Official

Name: MR. ROBERT GLEASON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 206-689-6680