Provider Demographics
NPI:1801519590
Name:BLOODLNK
Entity type:Organization
Organization Name:BLOODLNK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JJAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAZETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-587-4894
Mailing Address - Street 1:2505 FLAGLER AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3934
Mailing Address - Country:US
Mailing Address - Phone:305-896-0879
Mailing Address - Fax:
Practice Address - Street 1:2505 FLAGLER AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3934
Practice Address - Country:US
Practice Address - Phone:305-587-4894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty