Blanca Peak Inpatient Services LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BLANCA PEAK INPATIENT SERVICES LLC

Practice address

1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708

Phone

(973) 251-1132

NPI assigned

Aug 5, 2014

Last updated

Dec 9, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kathleen Kondas

Title

Officer

Phone

(973) 251-1132

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575849600000",
    "number": "1881003887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13737 NOEL RD",
            "address_2": "STE 1600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752401331",
            "telephone_number": "973-251-1132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476708",
            "telephone_number": "973-251-1132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLANCA PEAK INPATIENT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-05",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A",
        "authorized_official_last_name": "KONDAS",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "973-251-1132"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica W Black, LMHC
• Katherine Blackburn
• Laurel Blackerby
• Savannah Shirley Blacklidge, MS CY SLP
• Christian Constance Blackwell, RN MSN NP-C
• Robert Neil Blanchard, MD
• BLC Wellington - Fort Walton Beach, LLC (Brookdale Fort Walton Beach)
• BLC Westwood LLC (Westwood Health Care Center)
• Blessing Upon Blessing
• BLM First Assistant

• Internal Medicine Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; 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.