Provider Demographics
NPI:1659645356
Name:EPLRMC, PA
Entity Type:Organization
Organization Name:EPLRMC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:BLASCHKE II
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-979-9453
Mailing Address - Street 1:5400 MARYLAND WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5048
Mailing Address - Country:US
Mailing Address - Phone:615-979-9453
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL PARKWAY
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-1782
Practice Address - Country:US
Practice Address - Phone:817-451-4208
Practice Address - Fax:817-563-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty