Jeffrey James Blaauw, ATP

Primary specialty

Other TechnicianTaxonomy code 247200000X

License

ATP13882 Issued in TX

Practice address

2019 Summerhill Rd
Texarkana, TX 75501

Phone

(903) 223-9001

Fax

(903) 794-8666

NPI assigned

Aug 16, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534377600000",
    "number": "1497034888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 SUMMERHILL RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755013580",
            "telephone_number": "903-223-9001",
            "fax_number": "903-794-8666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2019 SUMMERHILL RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "75501",
            "telephone_number": "903-223-9001",
            "fax_number": "903-794-8666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAAUW",
        "first_name": "JEFFREY",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "ATP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-16",
        "last_updated": "2018-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "TX",
            "license": "ATP13882",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• April Blackwell
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• Charles Leonard Blankenship Jr., M.D.
• Rickie Bledsoe

• Other Technician in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Other Technician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.