1841245750 NPI number — MR. GEOFFREY M BLANKENSHIP PA

Table of content: MR. GEOFFREY M BLANKENSHIP PA (NPI 1841245750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841245750 NPI number — MR. GEOFFREY M BLANKENSHIP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANKENSHIP
Provider First Name:
GEOFFREY
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1841245750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1340 HAL GREER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-3804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-399-6727
Provider Business Mailing Address Fax Number:
304-399-6726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1340 HAL GREER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-3804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-399-6727
Provider Business Practice Location Address Fax Number:
305-399-6726
Provider Enumeration Date:
05/23/2006

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: 363A00000X , with the licence number:  PA972 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 01162 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001807775 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 7100014080 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00372230 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1841245750 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0188020 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1069705 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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