Provider Demographics
NPI:1700603115
Name:BLUE NILE CLINIC LAB
Entity type:Organization
Organization Name:BLUE NILE CLINIC LAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENGESHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-288-7337
Mailing Address - Street 1:11275 E MISSISSIPPI AVE STE 2W1
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2828
Mailing Address - Country:US
Mailing Address - Phone:720-573-3823
Mailing Address - Fax:720-639-9037
Practice Address - Street 1:11275 E MISSISSIPPI AVE STE 2W1
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2828
Practice Address - Country:US
Practice Address - Phone:720-573-3823
Practice Address - Fax:720-639-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory