Provider Demographics
NPI:1770725681
Name:BLUE INDUSTRIAL
Entity type:Organization
Organization Name:BLUE INDUSTRIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-567-0941
Mailing Address - Street 1:3333 BOWERS AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-2928
Mailing Address - Country:US
Mailing Address - Phone:408-567-0941
Mailing Address - Fax:925-439-7002
Practice Address - Street 1:3333 BOWERS AVE STE 130
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-2928
Practice Address - Country:US
Practice Address - Phone:408-567-0941
Practice Address - Fax:925-439-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty