1740327477 NPI number — BLATMAN PAIN CLINIC

Table of content: (NPI 1740327477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740327477 NPI number — BLATMAN PAIN CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLATMAN PAIN CLINIC
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:
1740327477
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:
10653 TECHWOOD CIR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-2833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-956-3200
Provider Business Mailing Address Fax Number:
513-956-3202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10653 TECHWOOD CIR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-956-3200
Provider Business Practice Location Address Fax Number:
513-956-3202
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLATMAN
Authorized Official First Name:
HAL
Authorized Official Middle Name:
SAMUEL
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
513-956-3200

Provider Taxonomy Codes

  • Taxonomy code: 2083P0500X , with the licence number:  35-04-7632 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208VP0000X , with the licence number: 35-04-7632 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 000000015391 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 027364930001 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 47632 03 . This is a "CHOICE CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0653056 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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