Provider Demographics
NPI:1568598365
Name:CARTER BLOODCARE
Entity Type:Organization
Organization Name:CARTER BLOODCARE
Other - Org Name:STEWART REGIONAL BLOOD CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-412-5120
Mailing Address - Street 1:2205 HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5950
Mailing Address - Country:US
Mailing Address - Phone:817-412-5000
Mailing Address - Fax:817-412-5991
Practice Address - Street 1:815 S BAXTER AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2205
Practice Address - Country:US
Practice Address - Phone:903-535-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-HL06Medicare ID - Type UnspecifiedHLA LABORATORY