Provider Demographics
NPI:1790021517
Name:BLACKFLY INVESTMENTS, LLC
Entity Type:Organization
Organization Name:BLACKFLY INVESTMENTS, LLC
Other - Org Name:MOLECULAR TESTING LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HURST-WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-208-0758
Mailing Address - Street 1:PO BOX 84770
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6070
Mailing Address - Country:US
Mailing Address - Phone:855-685-5227
Mailing Address - Fax:
Practice Address - Street 1:14401 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-3503
Practice Address - Country:US
Practice Address - Phone:855-685-5227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA50D2050397291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory