Provider Demographics
NPI:1154427854
Name:BLANCHARD VALLEY VASCULAR SURGERY ASSOCIATES LLC
Entity type:Organization
Organization Name:BLANCHARD VALLEY VASCULAR SURGERY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-420-9175
Mailing Address - Street 1:PO BOX 450637
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-0611
Mailing Address - Country:US
Mailing Address - Phone:800-514-4390
Mailing Address - Fax:440-808-3675
Practice Address - Street 1:1900 S MAIN ST
Practice Address - Street 2:CDS SUITE 349
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1214
Practice Address - Country:US
Practice Address - Phone:419-420-9175
Practice Address - Fax:419-420-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDD4087OtherRAILROAD CARE GROUP
OH9343571Medicare PIN