Provider Demographics
NPI:1831302991
Name:RC BLANE ENTERPRISES, PC
Entity Type:Organization
Organization Name:RC BLANE ENTERPRISES, PC
Other - Org Name:FOR YOUR FAMILY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:931-232-5555
Mailing Address - Street 1:1225 SPRING ST
Mailing Address - Street 2:PO BOX 219
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-3352
Mailing Address - Country:US
Mailing Address - Phone:931-232-5555
Mailing Address - Fax:931-232-5514
Practice Address - Street 1:1225 SPRING ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-0219
Practice Address - Country:US
Practice Address - Phone:931-232-5555
Practice Address - Fax:931-232-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3643402Medicaid
TNQ69931Medicare UPIN
TN3736580Medicare PIN