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General NPI Number Information
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NPI Number | 1255507737
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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 | 05/05/2008
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Last Update Date | 01/20/2024
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Provider Practice Location Address
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Address Line | 300A E MCKAY ST
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-9037
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Country | US
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Telephone | 910-862-5500
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Fax | 910-862-5501
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Provider Business Mailing Address
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Address Line | 300-A EAST MCKAY STREET
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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 | 910-862-6308
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Fax | 910-862-5501
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Authorized Official
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Title or Position | VP MANAGED CARE AND REVENUE CYCLE
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Name | JOSEPH B FISER
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Credential |
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Telephone | 910-615-5572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | H0154
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License Number State | NC
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