Provider Demographics
NPI:1013062736
Name:BLANKENSHIP, EDDY (RRT)
Entity Type:Individual
Prefix:MR
First Name:EDDY
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7719
Mailing Address - Country:US
Mailing Address - Phone:214-704-7744
Mailing Address - Fax:972-429-2027
Practice Address - Street 1:4415 PARKER RD
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7719
Practice Address - Country:US
Practice Address - Phone:214-704-7744
Practice Address - Fax:972-429-2027
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDMEH50339Medicaid
TX0509910001Medicare NSC