Healthcare Provider Details

I. General information

NPI: 1750214060
Provider Name (Legal Business Name): ERIC BLYTHE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S MERIDIAN ST
INDIANAPOLIS IN
46204-3530
US

IV. Provider business mailing address

711 W SMITH VALLEY RD
GREENWOOD IN
46142-3050
US

V. Phone/Fax

Practice location:
  • Phone: 317-606-6380
  • Fax:
Mailing address:
  • Phone: 317-726-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number5002
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: