MEDICARE: INLAND NORTHWEST BLOOD CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory
2	331L00000X	Blood Bank

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0005963W	OTHER	WA	L&I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679570485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND NORTHWEST BLOOD CENTER

Provider Business Mailing Address
First Line	:	210 W CATALDO AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2217
Country	:	US
Telephone Number	:	509-624-0151
Fax Number	:	509-232-4531

Provider Business Practice Location Address
First Line	:	210 W CATALDO AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2217
Country	:	US
Telephone Number	:	509-624-0151
Fax Number	:	509-232-4531

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MR. JEFF BRYANT
Credential	:
Telephone Number	:	506-232-4422

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/17/2012

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Directions to “INLAND NORTHWEST BLOOD CENTER ” Practice Location

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