Provider Demographics
NPI:1518145192
Name:NORTHERN CALIFORNIA COMMUNITY BLOOD BANK
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA COMMUNITY BLOOD BANK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHALLERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-443-8004
Mailing Address - Street 1:2524 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3229
Mailing Address - Country:US
Mailing Address - Phone:707-443-8004
Mailing Address - Fax:707-443-8007
Practice Address - Street 1:2524 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3229
Practice Address - Country:US
Practice Address - Phone:707-443-8004
Practice Address - Fax:707-443-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16642ZMedicare PIN