MEDICARE: BLANCO REGIONAL CLINIC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1760824387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLANCO REGIONAL CLINIC

Provider Business Mailing Address
First Line	:	825 4TH ST
Second Line	:
City	:	BLANCO
State	:	TX
Zip	:	78606-4913
Country	:	US
Telephone Number	:	830-833-5581
Fax Number	:	830-833-4933

Provider Business Practice Location Address
First Line	:	405 S US HIGHWAY 281
Second Line	:
City	:	JOHNSON CITY
State	:	TX
Zip	:	78636-4950
Country	:	US
Telephone Number	:	830-833-5581
Fax Number	:	830-833-4933

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	MR. MICHAEL EILERS
Credential	:
Telephone Number	:	830-456-6310

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/24/2013

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Directions to “BLANCO REGIONAL CLINIC ” Practice Location

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