Blackburn, Glenn Koontz
Blackburn, Glenn Koontz is an individual health care provider with primary practice located at Children'S Clinic 350 Langdon St., Somerset KY 42503. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as his primary health care specialty. Blackburn, Glenn Koontz can be contacted via phone (606) 678-8155.Contact Information
Primary practice address
Children'S Clinic 350 Langdon St.
Somerset KY 42503
Phone: (606) 678-8155
Fax: (606) 678-7548
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Adolescent Medicine | 2080A0000X | 16207 | Kentucky |
Profile Details
| NPI number | 1750351037 |
|---|---|
| LBN Legal business name | Blackburn, Glenn Koontz |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 26th, 2006 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750351037 | NPPES |
| Kentucky | MEDICAID | 64162076 |
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