Provider Demographics
NPI:1417123993
Name:BLADEN HEALTHCARE, LLC
Entity Type:Organization
Organization Name:BLADEN HEALTHCARE, LLC
Other - Org Name:CAPE FEAR VALLEY BMA BLADENBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CORP REVENUE CYCLE/MANAGED CARE
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:ATTN: PFS PROVIDER ENROLLMENT
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309
Mailing Address - Country:US
Mailing Address - Phone:910-862-6308
Mailing Address - Fax:910-862-5501
Practice Address - Street 1:1106 W SEABOARD ST
Practice Address - Street 2:
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320-6985
Practice Address - Country:US
Practice Address - Phone:910-863-3138
Practice Address - Fax:910-863-3597
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUMBERLAND COUNTY HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-05
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
NC34-4601AMedicaid
NC2351500Medicare PIN
NC34-4601AMedicaid