1265733745 NPI number — DAVID J BLAIR CRNA

Table of content: DAVID J BLAIR CRNA (NPI 1265733745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265733745 NPI number — DAVID J BLAIR CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAIR
Provider First Name:
DAVID
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265733745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
# L-3401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43260-3401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-615-1349
Provider Business Mailing Address Fax Number:
740-615-1344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
561 W CENTRAL AVE STE CBO
Provider Second Line Business Practice Location Address:
ATTN: HEATHER HAINEY
Provider Business Practice Location Address City Name:
DELAWARE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43015-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-615-1349
Provider Business Practice Location Address Fax Number:
740-615-1344
Provider Enumeration Date:
11/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC0200X , with the licence number:  363992 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: COA.12043-NA , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3103055 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".