Healthcare Provider Details

I. General information

NPI: 1609731892
Provider Name (Legal Business Name): BLADEN HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S MAIN ST
BLADENBORO NC
28320-8430
US

IV. Provider business mailing address

102 S MAIN ST
BLADENBORO NC
28320-8430
US

V. Phone/Fax

Practice location:
  • Phone: 910-863-3949
  • Fax: 910-863-3940
Mailing address:
  • Phone: 910-863-3949
  • Fax: 910-863-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH BART FISER
Title or Position: VP OF REV CYCLE AND MANAGED CARE
Credential:
Phone: 910-615-5572