Provider Demographics
NPI:1437223500
Name:BLAIR MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:BLAIR MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-349-5157
Mailing Address - Street 1:PO BOX 1600
Mailing Address - Street 2:
Mailing Address - City:SALYERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41465-1600
Mailing Address - Country:US
Mailing Address - Phone:606-349-5157
Mailing Address - Fax:606-349-5180
Practice Address - Street 1:723 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-9740
Practice Address - Country:US
Practice Address - Phone:606-349-5157
Practice Address - Fax:606-349-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000311891OtherANTHEM BC BS
KY90006248Medicaid
KY90006248Medicaid
KY4775800001Medicare ID - Type Unspecified