Provider Demographics
NPI:1952325557
Name:BLANCHARD FAMILY MEDICINE
Entity Type:Organization
Organization Name:BLANCHARD FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP, COO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:L
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-307-1000
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-485-9321
Mailing Address - Fax:405-485-3154
Practice Address - Street 1:1019 N COUNCIL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-8045
Practice Address - Country:US
Practice Address - Phone:405-485-9321
Practice Address - Fax:405-485-3154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700690MMedicaid
OK400522519Medicare PIN