Provider Demographics
NPI:1588662084
Name:BLOODWORKS
Entity Type:Organization
Organization Name:BLOODWORKS
Other - Org Name:PUGET SOUND BLOOD CENTER AND PROGRAM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-689-6680
Mailing Address - Street 1:921 TERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1239
Mailing Address - Country:US
Mailing Address - Phone:206-292-6500
Mailing Address - Fax:206-689-8365
Practice Address - Street 1:921 TERRY AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1239
Practice Address - Country:US
Practice Address - Phone:206-292-6500
Practice Address - Fax:206-689-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFX00004065291U00000X
WA331L00000X
WAPHWH.FX.600730653336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No331L00000XSuppliersBlood Bank
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1588662084Medicaid
WA2492700Medicaid
G-0001662200OtherMEDICARE PTAN
DO099OtherRR MEDICARE
AK1578921Medicaid
ID1588662084Medicaid