Provider Demographics
NPI:1740609858
Name:S.W. BLATCHLY, M.D., INC.
Entity Type:Organization
Organization Name:S.W. BLATCHLY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLATCHLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-498-1335
Mailing Address - Street 1:823 MICHIGAN ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2685
Mailing Address - Country:US
Mailing Address - Phone:937-498-1335
Mailing Address - Fax:937-498-1011
Practice Address - Street 1:823 MICHIGAN ST BLDG B
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2685
Practice Address - Country:US
Practice Address - Phone:937-498-1335
Practice Address - Fax:937-498-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty