Basic Information
| Provider Information | |||||||||
| NPI: | 1003840901 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLANKENSHIP | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3810 | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648033810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4174554200 | ||||||||
| FaxNumber: | 4174554314 | ||||||||
| Practice Location | |||||||||
| Address1: | 336 S JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | NEOSHO | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648501769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4174554200 | ||||||||
| FaxNumber: | 4174554314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 12/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2005009945 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2005009945 | MO | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 197311 | 01 | ANTHEM | OTHER | 207291402 | 05 | MO | MEDICAID | 100183010A | 05 | OK | MEDICAID | 200312050A | 05 | KS | MEDICAID | P00215074 | 01 | RR MEDICARE | OTHER |