Provider Demographics
NPI:1114269677
Name:BLADEN HEALTHCARE LLC
Entity Type:Organization
Organization Name:BLADEN HEALTHCARE LLC
Other - Org Name:BLADEN EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REV CYCLE/MANAGED CARE PLANNING
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:FISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-615-5572
Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:918-862-2122
Mailing Address - Fax:910-862-1279
Practice Address - Street 1:107 E DUNHAM ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-4300
Practice Address - Country:US
Practice Address - Phone:910-862-2122
Practice Address - Fax:910-862-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0154261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2351500Medicare PIN