Provider Demographics
NPI:1730410010
Name:BLEND INSTITUTE LLC
Entity type:Organization
Organization Name:BLEND INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-722-5600
Mailing Address - Street 1:1911 MANATEE AVE E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1562
Mailing Address - Country:US
Mailing Address - Phone:941-722-5600
Mailing Address - Fax:941-722-5644
Practice Address - Street 1:1911 MANATEE AVE E
Practice Address - Street 2:SUITE 102
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1562
Practice Address - Country:US
Practice Address - Phone:941-722-5600
Practice Address - Fax:941-722-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62136174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE41815Medicare UPIN
FL23974Medicare PIN