Lisa D Blankenship, MD
Individual provider Active NPI Physical Medicine & Rehabilitation Physician · Mountain Home, TN
NPI 1356432744 · NPPES record last updated Sep 10, 2010
Key facts
- NPI
- 1356432744
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- License
- 200100642 (NC)
- Practice address
- Dogwood Ave
Vamc
Mountain Home, TN 63684 - Phone
- (423) 926-1171
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160216002200 | TN | Order and Referring Only - Physical Medicine and Rehabilitation |
3173716628 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 200100642 | NC | Yes |
Addresses
Primary practice location
Dogwood Ave
Vamc
Mountain Home, TN 63684
Mailing address
PO Box 4000 (117)
PM&RS
Mountain Home, TN 37684
Phone (423) 926-1171
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89129E9 | Medicaid | NC |
Other providers in Mountain Home, TN
- William Robert Bettencourt
- Rhonda L. Bier
- Rebecca Ann Biggs-Parker
- Christopher Allen Blackburn
- William Tate Blalock
- Andrew H Bloch
- Nicole Cher Boatright
- Benny D Boggs Jr.
- Harold Ray Bohlman III
- Tawny Leigh Booher-Hale
All providers in Mountain Home, TN · Physical Medicine & Rehabilitation Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.