Healthcare Provider Details

I. General information

NPI: 1467373415
Provider Name (Legal Business Name): STEVIE LEE BLEVINS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 W BROAD ST
COLUMBUS OH
43204-1306
US

IV. Provider business mailing address

3121 W BROAD ST
COLUMBUS OH
43204-1306
US

V. Phone/Fax

Practice location:
  • Phone: 614-869-2002
  • Fax: 614-792-6240
Mailing address:
  • Phone: 614-446-5207
  • Fax: 614-792-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.007835
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: