Organization
BLAZE VALLEY CORPORATION
Active
Other names
Blaze Valley Home Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA L JAYME-MARTIN (PRESIDENT)
(606) 274-0156
Entity
Organization
Contact information
Practice address
974 PINEY GROVE RD, SOMERSET, KY 42501-5476
(606) 274-0156
(606) 274-0234
Mailing address
974 PINEY GROVE RD, SOMERSET, KY 42501-5476
(606) 274-0156
(606) 274-0234
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
HME00706
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100170560
—
KY
Enumeration date
04/04/2011
Last updated
01/31/2014
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