Provider Demographics
NPI:1073716312
Name:BLANCHARD VALLEY MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:BLANCHARD VALLEY MEDICAL ASSOCIATES, INC
Other - Org Name:BLANCHARD VALLEY MEDICAL ASSOCIATES LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:YUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-424-0380
Mailing Address - Street 1:200 W PEARL ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1332
Mailing Address - Country:US
Mailing Address - Phone:419-424-0380
Mailing Address - Fax:419-425-6755
Practice Address - Street 1:200 W PEARL ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1332
Practice Address - Country:US
Practice Address - Phone:419-424-0380
Practice Address - Fax:419-425-6755
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLANCHARD VALLEY MEDICAL ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-06
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3682941Medicare PIN