Provider Demographics
NPI:1306220140
Name:BLINCOE & SHUTT PSC
Entity Type:Organization
Organization Name:BLINCOE & SHUTT PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLINCOE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-895-2210
Mailing Address - Street 1:4122 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3242
Mailing Address - Country:US
Mailing Address - Phone:502-895-2210
Mailing Address - Fax:
Practice Address - Street 1:4122 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3242
Practice Address - Country:US
Practice Address - Phone:502-895-2210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty