1508222340 NPI number — BLANFORD PEDIATRIC THERAPY LLC

Table of content: (NPI 1508222340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508222340 NPI number — BLANFORD PEDIATRIC THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLANFORD PEDIATRIC THERAPY LLC
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:
PARTNERS IN PEDIATRIC THERAPY
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:
1508222340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 BLOOMFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARDSTOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40004-2025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-797-8223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 BLOOMFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARDSTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40004-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-331-5478
Provider Business Practice Location Address Fax Number:
502-348-9825
Provider Enumeration Date:
01/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BLANFORD
Authorized Official First Name:
LANCE
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
859-797-8223

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: 135224 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 140780 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100415400 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50115322 . This is a "PASSPORT HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100424590 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100387750 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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