Provider Demographics
NPI:1780195636
Name:INOVA BLOOD DONOR SERVICES
Entity Type:Organization
Organization Name:INOVA BLOOD DONOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE AND REG AFFAIRS MGR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-220-1736
Mailing Address - Street 1:45745 NOKES BLVD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2491
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45745 NOKES BLVD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-2491
Practice Address - Country:US
Practice Address - Phone:571-434-3623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INOVA HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical TechnologistGroup - Single Specialty