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General NPI Number Information
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NPI Number | 1669761391
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Entity Type | Organization
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Legal Business Name | BLAZE VALLEY CORPORATION
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | 974 PINEY GROVE RD
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City | SOMERSET
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State | KY
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Zip | 42501-5476
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Country | US
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Telephone | 606-274-0156
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Fax | 606-274-0234
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Provider Business Mailing Address
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Address Line | 974 PINEY GROVE RD
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City | SOMERSET
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State | KY
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Zip | 42501-5476
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Country | US
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Telephone | 606-274-0156
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Fax | 606-274-0234
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARIA L JAYME-MARTIN
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Credential |
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Telephone | 606-274-0156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | HME00706
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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