1144696626 NPI number — THOMAS BLAHOVEC P.T.

Table of content: THOMAS BLAHOVEC P.T. (NPI 1144696626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144696626 NPI number — THOMAS BLAHOVEC P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAHOVEC
Provider First Name:
THOMAS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1144696626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
KIMBROUGH AMBULATORY CARE CENTER 2481 LLEWELLYN AVE
Provider Second Line Business Mailing Address:
FORT GEORGE G. MEADE
Provider Business Mailing Address City Name:
FT. GEORGE G. MEADE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20755-5129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ANDREW RADER US ARMY HEALTH CLINIC 401 CARPENTER ROAD
Provider Second Line Business Practice Location Address:
RM 1042
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-853-1392
Provider Business Practice Location Address Fax Number:
888-501-0356
Provider Enumeration Date:
08/19/2015

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: 225100000X , with the licence number:  2305209101 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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