Healthcare Provider Details

I. General information

NPI: 1497346274
Provider Name (Legal Business Name): BLATCHFORD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E CHESTNUT AVE
ARKANSAS CITY KS
67005-2200
US

IV. Provider business mailing address

119 E CHESTNUT AVE
ARKANSAS CITY KS
67005-2200
US

V. Phone/Fax

Practice location:
  • Phone: 620-441-4108
  • Fax: 620-741-5093
Mailing address:
  • Phone: 620-441-4108
  • Fax: 620-741-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICK TYSON BLATCHFORD
Title or Position: MD
Credential:
Phone: 620-441-4108