Organization
BLAIR MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLAIR E BONE NP (OWNER, AUTHORIZED)
(618) 567-9821
Entity
Organization
Contact information
Practice address
13745 MARY LN, AVISTON, IL 62216-4732
(618) 567-9821
(618) 939-9836
Mailing address
PO BOX 306, COLUMBIA, IL 62236-0306
(618) 567-9821
(618) 939-9836
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
11/19/2020
Last updated
09/17/2021
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