=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437223500
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLAIR MEDICAL SUPPLIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 02/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 723 PARKWAY DR
-----------------------------------------------------
City | SALYERSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41465-9740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-349-5157
-----------------------------------------------------
Fax | 606-349-5180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1600
-----------------------------------------------------
City | SALYERSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41465-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-349-5157
-----------------------------------------------------
Fax | 606-349-5180
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRESIDENT
-----------------------------------------------------
Name | MRS. PHYLLIS ANNETTE BLAIR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-349-5157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------