1770698110 NPI number — MR. KIM EDWARD BLANKINSHIP RPH

Table of content: MR. KIM EDWARD BLANKINSHIP RPH (NPI 1770698110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770698110 NPI number — MR. KIM EDWARD BLANKINSHIP RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANKINSHIP
Provider First Name:
KIM
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1770698110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
331 CARSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSCLE SHOALS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35661-4538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-446-6397
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11601 HIGHWAY 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35648-3249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-229-5550
Provider Business Practice Location Address Fax Number:
256-229-5078
Provider Enumeration Date:
08/19/2006

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: 183500000X , with the licence number:  10076 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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