Provider Demographics
NPI:1306026828
Name:THE BLAINE CORPORATION
Entity type:Organization
Organization Name:THE BLAINE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ELDRIDGE
Authorized Official - Last Name:BLAINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:614-430-0100
Mailing Address - Street 1:959 WORTHINGTON WOODS LOOP RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43085-5743
Mailing Address - Country:US
Mailing Address - Phone:614-430-0100
Mailing Address - Fax:614-431-0101
Practice Address - Street 1:959 WORTHINGTON WOODS LOOP RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43085-5743
Practice Address - Country:US
Practice Address - Phone:614-430-0100
Practice Address - Fax:614-431-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003408213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2553062Medicaid
OH2553062Medicaid