=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508858481
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN W BLOINK MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 N CHESTNUT ST
-----------------------------------------------------
City | CORTEZ
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81321-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-565-5463
-----------------------------------------------------
Fax | 970-564-9245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 1509 118 N. CHESTNUT ST
-----------------------------------------------------
City | CORTEZ
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-565-5463
-----------------------------------------------------
Fax | 970-564-9245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. JACQUELINE N BLOINK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-565-5463
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 28892
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------