Provider Demographics
NPI:1891721320
Name:BLAYDES, MERIWETHER CARY (MD)
Entity type:Individual
Prefix:
First Name:MERIWETHER
Middle Name:CARY
Last Name:BLAYDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4661
Mailing Address - Fax:859-258-4620
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4661
Practice Address - Fax:859-258-4620
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13754207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYASC1019OtherMEDICARE ASC GROUP
KY37903705OtherMEDICAID LAB GROUP
KYCB5773OtherRR MEDICARE GROUP
KY36000818OtherMEDICAID ASC GROUP
KY4000501OtherMEDICARE LAB GROUP
KY64137540Medicaid
KY37903705OtherMEDICAID LAB GROUP
C64445Medicare UPIN