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General NPI Number Information
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NPI Number | 1154436012
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Entity Type | Organization
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Legal Business Name | BLADEN HEALTHCARE LLC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 507 DOCTOR'S DRIVE
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337
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Country | US
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Telephone | 910-862-3212
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Fax | 910-862-2263
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Provider Business Mailing Address
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Address Line | PO BOX 398
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-0398
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Country | US
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Telephone | 910-862-3212
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Fax | 910-862-2263
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Authorized Official
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Title or Position | REIMBURSEMENT DIRECTOR
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Name | MR. AYUB IBRAHIM JR.
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Credential |
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Telephone | 910-615-6994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 15560
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License Number State | NC
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