Healthcare Provider Details

I. General information

NPI: 1093476228
Provider Name (Legal Business Name): ISAAC BLAINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 OHIO RIVER RD STE B
WHEELERSBURG OH
45694-1713
US

IV. Provider business mailing address

17463 E KY 8
QUINCY KY
41166-8939
US

V. Phone/Fax

Practice location:
  • Phone: 740-529-1201
  • Fax: 740-876-8854
Mailing address:
  • Phone: 740-821-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: