Provider Demographics
NPI:1134156979
Name:BLAIR MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:BLAIR MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECTS MGR.
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:8149-497-6211
Mailing Address - Street 1:1414 9TH AVE
Mailing Address - Street 2:STATION MEDICAL CENTER
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2415
Mailing Address - Country:US
Mailing Address - Phone:814-949-7621
Mailing Address - Fax:814-949-7616
Practice Address - Street 1:1414 9TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2454
Practice Address - Country:US
Practice Address - Phone:814-949-7621
Practice Address - Fax:814-949-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002353L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007393100001OtherPODIATRY MED. ASST. #
PA0719120001OtherDMERC PROVIDER NUMBER
PA1015429OtherPODIATRY GHP #
PA117185OtherHIGHMARK
PA117185OtherHIGHMARK