Provider Demographics
NPI:1427008606
Name:BLANCHARD, INC
Entity Type:Organization
Organization Name:BLANCHARD, INC
Other - Org Name:DIRECT DIABETES SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-998-5551
Mailing Address - Street 1:13402 N SCOTTSDALE RD
Mailing Address - Street 2:STE A125
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4054
Mailing Address - Country:US
Mailing Address - Phone:480-998-5551
Mailing Address - Fax:480-998-5247
Practice Address - Street 1:13402 N SCOTTSDALE RD
Practice Address - Street 2:STE A125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4054
Practice Address - Country:US
Practice Address - Phone:480-998-5551
Practice Address - Fax:480-998-5247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01011146332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2194067Medicaid
IA0522813Medicaid
NC7703167Medicaid
NM0000A8177Medicaid
CO35179856Medicaid
KY90003385Medicaid
CAXDME01858Medicaid
LA1567507Medicaid
AZ459017Medicaid
OH2194067Medicaid
NC7703167Medicaid
NE=========54Medicaid