DR. GLENN KOONTZ BLACKBURN JR. (NPI# 1750351037) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750351037 |
| Entity Type | Individual |
| Full Name | DR. GLENN KOONTZ BLACKBURN JR. |
| Credential | M.D. |
| Practice Address |
Children's Clinic 350 Langdon St. Somerset KY 42503 |
| Practice Telephone | 6066788155 |
| Practice Fax Number | 6066787548 |
| Mailing Telephone | 6066788155 |
| Mailing Fax Number | 6066787548 |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
16207 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 64162076 | 05 |
| Street Address |
CHILDREN'S CLINIC 350 LANGDON ST. |
| City | SOMERSET |
| State | KY |
| Zip Code | 42503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972573269 | Dana Lynn Gibson | Pediatrics | Children's Clinic, 350 Langdon Street, Somerset, KY 42503-2867 | 2006-01-26 |
| 1407826795 | Michael Dorian Mcbride | Pediatrics | Children's Clinic, 350 Langdon Street, Somerset, KY 42503-2786 | 2006-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023669652 | Carehere LLC | Family Medicine | Carehere Clinic- Toyotetsu Somerset Ky, 80 Pin Oak, Somerset, KY 42503 | 2019-09-25 |
| 1841859766 | Armina Jo Hoeck | Behavior Technician | Kid Spot Center, 200 Tower Circle, Somerset, KY 42503 | 2019-06-13 |
| 1548723042 | Lisa Hunter | Counselor | 225 Ky 2227, Somerset, KY 42503 | 2019-04-11 |
| 1982171237 | Bluegrass Hearing Clinic, LLC | Audiologist | 25 Medpark West, Suite 2, Somerset, KY 42503 | 2018-10-25 |
| 1780109116 | Kentucky Diagnostic Ultrasound, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 324 Water Cliff Dr., Somerset, KY 42503 | 2017-08-07 |
| 1689115172 | Lake Cumberland Physician Practices LLC | Internal Medicine | 154 Bogle Office Park Dr Ste B, Somerset, KY 42503 | 2017-03-16 |
| 1811356892 | Lake Cumberland Physician Practices, LLC | Nurse Practitioner | 27 Imaging Dr, Suite B, Somerset, KY 42503 | 2016-02-18 |
| 1730586447 | Amy Molen | Counselor | 259 Parkers Mill Road, Somerset, KY 42503 | 2014-11-24 |
| 1841630654 | Eastern Pulaski Rural Health Clinic,pllc | Clinic/Center | 31 Mark Shopville Rd, Somerset, KY 42503 | 2013-06-26 |
| 1881978807 | Nathan S Fisher | Counselor | 600 Clifty St Ste 2, Somerset, KY 42503 | 2011-10-10 |
| Find all providers in zip 42503 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861552671 | Manju Misra | Pediatrics | 1553 State Route 27 Ste 2500, Somerset, NJ 08873-3982 | 2006-12-11 |
| 1144580267 | Manju Misra Md PC | Pediatrics | 1553 State Route 27, Suite 2500, Somerset, NJ 08873-3980 | 2012-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154715159 | Gregory Tracy | Pediatrics | 3050 Harrodsburg Rd Ste 100, Lexington, KY 40503 | 2015-03-27 |
| 1497088090 | Henderson Pediatrics, Psc | Pediatrics | 1035 N Elm St, Henderson, KY 42420-2712 | 2009-09-14 |
| 1679773154 | Sheila M Guelda Md Pllc | Pediatrics | 2809 N Hurstbourne Pkwy, Suite 109, Louisville, KY 40223-1279 | 2007-07-23 |
| 1235296617 | Suzanne L Woods | Pediatrics | 301 C Middletown Park Place, Louisville, KY 40243 | 2007-01-03 |
| 1811062151 | Winit Chartisathian | Pediatrics | 73 Kingswood Dr, Campbellsville, KY 42718-9604 | 2006-11-22 |
| 1871694174 | Angelito L Samson | Pediatrics | 150 Frankfort Rd, Suite 101, Shelbyville, KY 40065-9433 | 2006-09-26 |
| 1558376392 | Robert J Tagher | Pediatrics | 7409 Us Highway 42, Florence, KY 41042-1905 | 2006-07-30 |
| 1710947817 | Paul J Janson | Pediatrics | 7370 Turfway Road, Suite 280, Florence, KY 41042 | 2006-03-24 |
| 1457331555 | Debra R. Bailey | Pediatrics | 419 Town Mountain Road, Suite 202, Pikeville, KY 41501-1633 | 2006-01-17 |
| 1700863230 | Dana J Distler | Pediatrics | 301 Middletown Park Pl, Suite C, Louisville, KY 40243-2515 | 2005-12-27 |
| 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.