1427008606 NPI number — BLANCHARD, INC

Table of content: (NPI 1427008606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427008606 NPI number — BLANCHARD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLANCHARD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIRECT DIABETES SUPPLY
Provider Other Organization Name Type Code:
3
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:
1427008606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13402 N SCOTTSDALE RD
Provider Second Line Business Mailing Address:
STE A125
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85254-4054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-998-5551
Provider Business Mailing Address Fax Number:
480-998-5247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13402 N SCOTTSDALE RD
Provider Second Line Business Practice Location Address:
STE A125
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85254-4054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-998-5551
Provider Business Practice Location Address Fax Number:
480-998-5247
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLANCHARD
Authorized Official First Name:
SIMONE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-998-5551

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  01011146 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2194067 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0522813 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7703167 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000A8177 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35179856 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90003385 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: XDME01858 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1567507 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 459017 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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