Provider Demographics
NPI:1457469165
Name:BLADEN MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:BLADEN MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-862-5500
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-0517
Mailing Address - Country:US
Mailing Address - Phone:910-862-5500
Mailing Address - Fax:910-862-2107
Practice Address - Street 1:300 E MCKAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-0517
Practice Address - Country:US
Practice Address - Phone:910-862-5500
Practice Address - Fax:910-862-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29651207Q00000X
NC22998207R00000X
NC200101455207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343966AMedicaid
NC343966Medicare ID - Type UnspecifiedBMA ELIZABETHTOWN
NCC88440Medicare UPIN
NC343966AMedicaid
NCF08812Medicare UPIN