Provider Demographics
NPI:1205957214
Name:BLADEN MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:BLADEN MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-862-5507
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28332-0087
Mailing Address - Country:US
Mailing Address - Phone:910-862-3528
Mailing Address - Fax:910-862-2207
Practice Address - Street 1:16 3RD STREET
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:NC
Practice Address - Zip Code:28332
Practice Address - Country:US
Practice Address - Phone:910-862-3528
Practice Address - Fax:910-862-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29651207Q00000X
NC200746363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295824910OtherNPI
NC348935AMedicaid
NC1225127459OtherNPI
29651OtherLICENSE NUMBER
NC8971626Medicaid
NC348935Medicare ID - Type Unspecified
1295824910OtherNPI