Individual
JASON H BLASENAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
701 GROVE RD, GMH ER ADMINISTRATION, GREENVILLE, SC 29605-5611
(864) 455-6372
Mailing address
255 ENTERPRISE BLVD, SUITE 250, GREENVILLE, SC 29615-6300
(864) 454-0888
(864) 454-1130
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
22902
MS
207P00000X
Emergency Medicine Physician
Primary
978
SC
207P00000X
Emergency Medicine Physician
OS18227
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009788
—
SC
01
—
57-6007863
BCBS OF SOUTH CAROLINA
SC
01
—
P00379730
RAILROAD MEDICARE
SC
Enumeration date
07/20/2006
Last updated
07/19/2022
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