| Blair Medical LLC | |
|
13745 Mary Ln Aviston IL 62216-4732 | |
| (618) 567-9821 | |
| (618) 939-9836 |
| Full Name | Blair Medical LLC |
|---|---|
| Speciality | Nurse Practitioner - Family |
| Location | 13745 Mary Ln, Aviston, Illinois |
| Authorized Official Name and Position | Blair E Bone (OWNER, AUTHORIZED) |
| Authorized Official Contact | 6185679821 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blair Medical LLC Po Box 306 Columbia IL 62236-0306 Ph: (618) 567-9821 | Blair Medical LLC 13745 Mary Ln Aviston IL 62216-4732 Ph: (618) 567-9821 |
| NPI Number | 1427651587 |
|---|---|
| Provider Enumeration Date | 11/19/2020 |
| Last Update Date | 09/17/2021 |
| Certification Date | 09/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427651587 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | () | Secondary |
| 363LF0000X | Nurse Practitioner - Family | () | Primary |
| 363LP2300X | Nurse Practitioner - Primary Care | () | Secondary |