Provider Demographics
NPI:1972783025
Name:JABEZ-BLOCHER, INC.
Entity Type:Organization
Organization Name:JABEZ-BLOCHER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SHERMAN
Authorized Official - Last Name:BLOCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-200-3016
Mailing Address - Street 1:8490 S POWER RD
Mailing Address - Street 2:#105-244
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-8028
Mailing Address - Country:US
Mailing Address - Phone:480-200-3016
Mailing Address - Fax:
Practice Address - Street 1:7400 S POWER RD
Practice Address - Street 2:#120
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-9281
Practice Address - Country:US
Practice Address - Phone:480-200-3016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0359213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ315227Medicaid
AZ315227Medicaid
AZZ119697Medicare PIN