Basic Information
| Provider Information | |||||||||
| NPI: | 1427293950 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLOUNT EMERGENCY PHYSICIANS, LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2391 | ||||||||
| Address2: | MSC # 416 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352012391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052743000 | ||||||||
| FaxNumber: | 2053135245 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 GILBREATH DR | ||||||||
| Address2: | |||||||||
| City: | ONEONTA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351212827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052743000 | ||||||||
| FaxNumber: | 2053135245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2008 | ||||||||
| LastUpdateDate: | 12/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | BALENTINE | ||||||||
| AuthorizedOfficialFirstName: | BRYAN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2052743000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.