Healthcare Provider Details

I. General information

NPI: 1730906348
Provider Name (Legal Business Name): BLANE CLINICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 DONELSON PKWY
DOVER TN
37058-3724
US

IV. Provider business mailing address

1307 DONELSON PKWY
DOVER TN
37058-3724
US

V. Phone/Fax

Practice location:
  • Phone: 931-232-0123
  • Fax: 931-232-1185
Mailing address:
  • Phone: 931-232-0123
  • Fax: 931-232-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARLIN BLANE
Title or Position: AO
Credential:
Phone: 312-820-1126