Provider Demographics
NPI:1831664515
Name:A WORKSAFE SERVICE, INC.
Entity Type:Organization
Organization Name:A WORKSAFE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-391-9363
Mailing Address - Street 1:1696 CAPITOL ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-7855
Mailing Address - Country:US
Mailing Address - Phone:503-391-9363
Mailing Address - Fax:503-316-9110
Practice Address - Street 1:1696 CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-7855
Practice Address - Country:US
Practice Address - Phone:503-391-9363
Practice Address - Fax:503-316-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory