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1164408464 NPI number — EMMETT BLOUNT III IDHS

NPI Number: 1164408464
Health Care Provider/Practitioner: EMMETT BLOUNT III IDHS

Information about “1164408464” NPI (EMMETT BLOUNT III IDHS) exists in 1164408464 in HTML format HTML  |  1164408464 in plain Text format TXT  |  1164408464 in PDF (Portable Document Format) PDF  |  1164408464 in an XML format XML  formats.

NPI Number : 1164408464 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164408464",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLOUNT",
    "FirstName": "EMMETT",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": "III",
    "Credential": "IDHS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1260 SHOTGUN RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHESAPEAKE",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23322-4505",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-421-1800",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1317 BALLAHACK RD",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "CHESAPEAKE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23322-2499",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-421-8220",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/19/2005",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1710I1002X",
          "TaxonomyName": "Independent Duty Corpsman",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1710I1003X",
          "TaxonomyName": "Independent Duty Medical Technicians",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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