MEDICARE: LEE ANN BLALOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor		CO

General Provider Information

NPI Number	:	1568796050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE ANN BLALOCK

Provider Business Mailing Address
First Line	:	2000 S COLUMBINE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4321
Country	:	US
Telephone Number	:	404-583-2258
Fax Number	:	303-333-4097

Provider Business Practice Location Address
First Line	:	2000 S COLUMBINE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4321
Country	:	US
Telephone Number	:	404-583-2258
Fax Number	:	303-333-4097

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	09/30/2009

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Directions to “ LEE ANN BLALOCK ” Practice Location

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