MEDICARE: BLOWN, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1744P3200X	Prosthetics Case Management
2	335E00000X	Prosthetic/Orthotic Supplier
3	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1760258818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOWN, LLC

Provider Business Mailing Address
First Line	:	6001 RIVER RD STE 210
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-4574
Country	:	US
Telephone Number	:	706-708-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 RIVER RD STE 210
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-4574
Country	:	US
Telephone Number	:	706-708-9090
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHANEA BUIE
Credential	:
Telephone Number	:	706-708-9090

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	05/06/2024

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