Provider Demographics
NPI:1760089791
Name:BLANCHARD MEDICAL
Entity Type:Organization
Organization Name:BLANCHARD MEDICAL
Other - Org Name:BLANCHARD MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAKOTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-375-4097
Mailing Address - Street 1:5948 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-2017
Mailing Address - Country:US
Mailing Address - Phone:318-375-0001
Mailing Address - Fax:318-375-0002
Practice Address - Street 1:5948 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-2017
Practice Address - Country:US
Practice Address - Phone:318-375-0001
Practice Address - Fax:318-375-0002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CADDO HOSPITAL SERVICE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-02
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2570587Medicaid