Provider Demographics
NPI:1508858481
Name:STEVEN W BLOINK MD PC
Entity Type:Organization
Organization Name:STEVEN W BLOINK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:BLOINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-565-5463
Mailing Address - Street 1:P.O. BOX 1509
Mailing Address - Street 2:118 N. CHESTNUT ST
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321
Mailing Address - Country:US
Mailing Address - Phone:970-565-5463
Mailing Address - Fax:970-564-9245
Practice Address - Street 1:118 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3104
Practice Address - Country:US
Practice Address - Phone:970-565-5463
Practice Address - Fax:970-564-9245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01288927Medicaid
CO87039842Medicaid
CO01288927Medicaid
09561Medicare ID - Type Unspecified