Provider Demographics
NPI:1790326502
Name:BLAZING GRACE MEDICAL, LLC
Entity Type:Organization
Organization Name:BLAZING GRACE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OBIOMA
Authorized Official - Middle Name:NNAMDI
Authorized Official - Last Name:ONUORAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-578-1714
Mailing Address - Street 1:2338 W 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4620
Mailing Address - Country:US
Mailing Address - Phone:918-577-2557
Mailing Address - Fax:509-578-1715
Practice Address - Street 1:953 STEVENS DR STE C
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3533
Practice Address - Country:US
Practice Address - Phone:509-578-1714
Practice Address - Fax:509-578-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty