1669521480 NPI number — DR. RICHARD BLANKS M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669521480 NPI number — DR. RICHARD BLANKS M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BLANKS

Provider First Name:

RICHARD

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1669521480

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/20/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

611 W PARK ST

Provider Second Line Business Mailing Address:

FAPC

Provider Business Mailing Address City Name:

URBANA

Provider Business Mailing Address State Name:

IL

Provider Business Mailing Address Postal Code:

61801

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

217-902-5292

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1802 S MATTIS AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CHAMPAIGN

Provider Business Practice Location Address State Name:

IL

Provider Business Practice Location Address Postal Code:

61821-5923

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

217-383-1850

Provider Business Practice Location Address Fax Number:

217-383-3439

Provider Enumeration Date:

01/10/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2084F0202X , with the licence number:  223476 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: Q0024X . This is a "SC MEDICAID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 1669521480 . This is a "SANDHILLS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1669521480 . This is a "UBH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1669521480 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1669521480 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 277884 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 9323083 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1669521480 . This is a "CAROLINA BEHAVIORAL HEALTH ALL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 185TN . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1669521480 . This is a "TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1669521480 . This is a "CENTERPOINT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 3021917 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".