MR. HENRY KEILER BLUHM JR. (NPI# 1104096429) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104096429 |
| Entity Type | Individual |
| Full Name | MR. HENRY KEILER BLUHM JR. |
| Credential | PA-C |
| Practice Address |
304a E 4th St Eldon MO 65026 |
| Mailing Address |
1005 Se Walton Blvd Bentonville AR 72712-6775 |
| Practice Telephone | 5735572400 |
| Practice Fax Number | 5735572401 |
| Mailing Telephone | 4792546734 |
| Mailing Fax Number | 4792546836 |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2018-08-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | PA-461 | AR | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
2011035886 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
0110002717 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | STATE LICENSE | 2011035886 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1005 Se Walton Blvd, Bentonville, AR 727126775 | 4792546734 | 4792546836 |
| Street Address |
304A E 4TH ST |
| City | ELDON |
| State | MO |
| Zip Code | 65026 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205835303 | Paul Bernabe | Family Medicine | 304a E 4th St, Eldon, MO 65026-1808 | 2005-07-20 |
| 1679114722 | Kayla Jean Blaes | Nurse Practitioner | 304a E 4th St, Eldon, MO 65026-1808 | 2019-09-30 |
| 1205280427 | Evgeniya Banina | Internal Medicine | 304a E 4th St, Eldon, MO 65026 | 2016-04-14 |
| 1639584139 | Rene L. Revelle | Nurse Practitioner | 304a E 4th St, Eldon, MO 65026-1808 | 2014-06-24 |
| 1053427492 | Lake Regional Health System | Clinic/Center | 304a E 4th St, Eldon, MO 65026-1808 | 2006-08-21 |
| 1194758011 | Christine Ann Livek | Family Medicine | 304a E 4th St, Eldon, MO 65026-1808 | 2006-07-07 |
| 1548205966 | Laura M Thompson | Nurse Practitioner | 304a E 4th St, Eldon, MO 65026-1808 | 2006-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235200965 | King Dental Clinic | Dentist | 102 East 9th Street, Eldin, MO 65026 | 2006-11-13 |
| 1154408425 | Miller County Ambulance District | Ambulance | 1304 South Aurora St., Eldon, MO 65026 | 2006-11-01 |
| 1285742684 | Malcolm J Dickerson | Family Medicine | 411 W 4th, Eldon, MO 65026 | 2006-08-26 |
| 1518908953 | Dillon Companies LLC | Durable Medical Equipment & Medical Supplies | 410 E North St, Eldon, MO 65026 | 2006-06-09 |
| 1285606392 | Capital Region Medical Center | Nurse Practitioner | 103 Business Hwy 54 North, Eldon, MO 65026 | 2006-02-02 |
| 1225024839 | Julie L. Russell | Nurse Practitioner | 304 A East 4th St, Eldon, MO 65026 | 2005-09-20 |
| 1770090490 | Lisa Renee Zaritz | Counselor | 206 S Mill St, Eldon, MO 65026 | 2018-01-03 |
| 1912417502 | Richard Mark Anderegg | Counselor | 206 S Mill St, Eldon, MO 65026 | 2017-10-09 |
| 1457888901 | Tiffany George | Counselor | 206 S Mill St, Eldon, MO 65026 | 2017-05-16 |
| 1972575694 | Michael Scott Griswold | Family Medicine | 103 Business Hwy 54 North, Eldon, MO 65026 | 2006-02-06 |
| Find all providers in zip 65026 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922628528 | Sarah Benson | Physician Assistant | 26791 Andrews Ln, Warrenton, MO 63383-6240 | 2020-04-23 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1912538752 | Karen Anghel | Physician Assistant | 804 S Kisner Dr, Independence, MO 64056-3062 | 2020-01-30 |
| 1457822082 | Jwan Alallaf | Physician Assistant | 4121 Roanoke Rd Apt 18, Kansas City, MO 64111-4053 | 2018-12-07 |
| 1730602921 | Saurav N Kayastha | Physician Assistant | 13013 Fuller Ave Ste A, Grandview, MO 64030-2687 | 2017-07-19 |
| 1891227393 | Hollis Smith | Physician Assistant | 2015 Maplewood Commons Dr, Saint Louis, MO 63143-1003 | 2017-04-03 |
| 1992165104 | Cassie Mcgee | Physician Assistant | 1051 Jones St, Kennett, MO 63857-3866 | 2016-03-01 |
| 1033462387 | Miguel Angel Medina | Physician Assistant | 1900 South Sunshine Ave., Springfield, MO 65807 | 2012-10-24 |
| 1699084814 | Travis James Weiss | Physician Assistant | 6724 State Highway 77, Benton, MO 63736-8238 | 2010-10-05 |
| 1235453150 | James F Patton | Physician Assistant | 913 South St, Stockton, MO 65785-9381 | 2010-03-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.