Provider Demographics
NPI:1891799789
Name:BLANCHARD VALLEY PEDIATRICS, INC.
Entity Type:Organization
Organization Name:BLANCHARD VALLEY PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-424-1922
Mailing Address - Street 1:1818 CHAPEL DR
Mailing Address - Street 2:STE D
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1344
Mailing Address - Country:US
Mailing Address - Phone:419-424-1922
Mailing Address - Fax:419-424-1927
Practice Address - Street 1:1818 CHAPEL DR
Practice Address - Street 2:STE D
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1344
Practice Address - Country:US
Practice Address - Phone:419-424-1922
Practice Address - Fax:419-424-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH055388Medicaid