1578660296 NPI number — OLIVE L BLAIR-LINEHAN CRNA

Table of content: OLIVE L BLAIR-LINEHAN CRNA (NPI 1578660296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578660296 NPI number — OLIVE L BLAIR-LINEHAN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAIR-LINEHAN
Provider First Name:
OLIVE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1578660296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-0447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-384-7840
Provider Business Mailing Address Fax Number:
704-384-7830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1530 N LIMESTONE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAFFNEY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29340-4742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-489-3286
Provider Business Practice Location Address Fax Number:
864-489-6694
Provider Enumeration Date:
09/17/2006

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: 367500000X , with the licence number:  1401 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20-2660098 . This is a "GAFFNEY MEDICAL ASSOCIATE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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