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Contact Information

BLAYNE K STREET, DO
301 JENNY GEORGE LANE
BUILDING B, SUITE 5
SWEETWATER, TX79556
 Phone: 325-219-6175
 Fax: 325-219-6179
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Family Medicine - Sports Medicine

207QS0010X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for BLAYNE K STREET · (Male)

NPI Number 1568811636
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 06/08/2016
Last updated 06/13/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • TX License # S6314
  • TX Medicaid 426407901
Hospital affiliation(s)
  • ROLLING PLAINS MEMORIAL HOSPITAL - (Acute Care)
    200 E ARIZONA
    SWEETWATER, TX 79556
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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