Provider Demographics
NPI:1093476228
Name:BLAINE, ISAAC
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:BLAINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17463 E KY 8
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:KY
Mailing Address - Zip Code:41166-8939
Mailing Address - Country:US
Mailing Address - Phone:740-821-3772
Mailing Address - Fax:
Practice Address - Street 1:8308 OHIO RIVER RD STE B
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1713
Practice Address - Country:US
Practice Address - Phone:740-529-1201
Practice Address - Fax:740-876-8854
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator