Provider Demographics
NPI:1487836359
Name:HAROLD W BLANTON
Entity Type:Organization
Organization Name:HAROLD W BLANTON
Other - Org Name:MIDWEST REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-626-8110
Mailing Address - Street 1:1512 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-2968
Mailing Address - Country:US
Mailing Address - Phone:815-626-8110
Mailing Address - Fax:815-625-2180
Practice Address - Street 1:1512 5TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-2968
Practice Address - Country:US
Practice Address - Phone:815-626-8110
Practice Address - Fax:815-625-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6062060001Medicare NSC