1205932670 NPI number — LINDA M. BLUNT, M.D., PLLC

Table of content: (NPI 1205932670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205932670 NPI number — LINDA M. BLUNT, M.D., PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINDA M. BLUNT, M.D., PLLC
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:
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:
1205932670
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:
PO BOX 695
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAREMORE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74018-0695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-343-3339
Provider Business Mailing Address Fax Number:
918-341-3212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 E PATTI PAGE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMORE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74017-8218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-343-3339
Provider Business Practice Location Address Fax Number:
918-341-3212
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLUNT
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
918-343-3339

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  21795 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 410260696-001 . This is a "BLUECROSS BLUESHIELD ID#" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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