MEDICARE: SAMUEL BLOUNT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1164236022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL BLOUNT

Provider Business Mailing Address
First Line	:	4520 N GRAND BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5943
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 N GRAND BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5943
Country	:	US
Telephone Number	:	405-618-8698
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	02/03/2025

Similar Medicare Providers

1295891927 — MS. JESSICA DISLA LCSW
Practice Location Address:

2641 KENNEDY BLVD
JERSEY CITY, NJ
07306-5943

Practice Phone: 201-761-6417
Practice Fax:

1427233527 — MR. KEVIN WEISBACH MS, ATC
Practice Location Address:

2641 KENNEDY BLVD
JERSEY CITY, NJ
07306-5943

Practice Phone: 201-761-7326
Practice Fax:

1851782890 — MEGAN DIANE SHAH P.A.-C
Practice Location Address:

4320 WORNALL RD STE 50
KANSAS CITY, MO
64111-5943

Practice Phone: 816-931-3312
Practice Fax: 816-889-1584

1811381155 — ANGEL LEONEL MONTANEZ MS, ATC, PES
Practice Location Address:

2641 KENNEDY BLVD
JERSEY CITY, NJ
07306-5943

Practice Phone: 201-761-7326
Practice Fax: 201-761-7314

1548634561 — VICTORIA BANDY RD
Practice Location Address:

103 SONOMA CT
STEPHENS CITY, VA
22655-5943

Practice Phone: 540-532-3271
Practice Fax:

1457713687 — LAURA STOCKAMP FNP, C
Practice Location Address:

4320 WORNALL RD STE 50
KANSAS CITY, MO
64111-5943

Practice Phone: 816-931-3312
Practice Fax: 816-531-9862

Directions to “ SAMUEL BLOUNT ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.