Provider Demographics
NPI:1558506816
Name:JAMES BLAIR BLANKENSHIP, PA
Entity Type:Organization
Organization Name:JAMES BLAIR BLANKENSHIP, PA
Other - Org Name:DBA NEUROSURGERY SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-582-9025
Mailing Address - Street 1:2793 E MILLENNIUM DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:479-582-9025
Mailing Address - Fax:479-582-1572
Practice Address - Street 1:2793 E MILLENNIUM DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-582-9025
Practice Address - Fax:479-582-1572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50947Medicare PIN
ARC67974Medicare UPIN