Provider Demographics
NPI:1649425299
Name:BLANE, JAMES ARTHUR IV (ORTH TECH, LPN)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ARTHUR
Last Name:BLANE
Suffix:IV
Gender:M
Credentials:ORTH TECH, LPN
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Mailing Address - Street 1:1481 W 10TH ST
Mailing Address - Street 2:PROSTHETICS 121
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2803
Mailing Address - Country:US
Mailing Address - Phone:317-988-4198
Mailing Address - Fax:317-988-4835
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:PROSTHETICS 121
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-4198
Practice Address - Fax:317-988-4835
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
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Provider Licenses
StateLicense IDTaxonomies
IN27014616A164W00000X
225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No164W00000XNursing Service ProvidersLicensed Practical Nurse