Provider Demographics
NPI:1659420800
Name:HAROLD W. BLEVINS, M.D.,P.S.C.
Entity Type:Organization
Organization Name:HAROLD W. BLEVINS, M.D.,P.S.C.
Other - Org Name:ENT ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-897-7300
Mailing Address - Street 1:3999 DUTCHMANS LN STE 3A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4747
Mailing Address - Country:US
Mailing Address - Phone:502-897-7300
Mailing Address - Fax:502-897-3332
Practice Address - Street 1:3999 DUTCHMANS LN STE 3A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4747
Practice Address - Country:US
Practice Address - Phone:502-897-7300
Practice Address - Fax:502-897-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200458400AMedicaid
000000057654OtherUNICARE NUMBER
KY1051605OtherPASSPORT GROUP #
KY000000057654OtherANTHEM GROUP NUMBER
CB3563OtherR R MEDICARE NUMBER
KY2433078000OtherPASSPORT ADVANTAGE
KY2433078000OtherPASSPORT ADVANTAGE
IN200458400AMedicaid
KY1051605OtherPASSPORT GROUP #
KY000000057654OtherANTHEM GROUP NUMBER