Provider Demographics
NPI:1740259670
Name:LANE MEMORIAL BLOOD BANK
Entity type:Organization
Organization Name:LANE MEMORIAL BLOOD BANK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-484-9111
Mailing Address - Street 1:2211 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2847
Mailing Address - Country:US
Mailing Address - Phone:541-484-9111
Mailing Address - Fax:541-484-6976
Practice Address - Street 1:2211 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2847
Practice Address - Country:US
Practice Address - Phone:541-484-9111
Practice Address - Fax:541-484-6976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCKLXMedicare PIN
ORR0000WCKLXMedicare ID - Type UnspecifiedPROVIDER ID
OROR02855Medicare ID - Type UnspecifiedTRADING PARTNER ID