Basic Information
| Provider Information | |||||||||
| NPI: | 1952374977 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLANCHARD VALLEY PATHOLOGY & LAB INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3455 MILL RUN DR | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430269078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774626017 | ||||||||
| FaxNumber: | 6147712248 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 S MAIN ST | ||||||||
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| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458401214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194235322 | ||||||||
| FaxNumber: | 4194235125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 02/01/2012 | ||||||||
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| AuthorizedOfficialLastName: | PRAPROTNIK | ||||||||
| AuthorizedOfficialFirstName: | DARJA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4194235322 | ||||||||
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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 | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 000000026629 | 01 | OH | ANTHEM | OTHER | 0513180 | 05 | OH | MEDICAID |