MARK LEE BLANTON — NPI 1053901272 (Licensed & Credentialed Suppliers — Pharmacy, Community

CMS-1500 Box 24J / 33a • NPI

1053901272

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

3336C0003X (CMS 58)

Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy

Box 32 Service Location & ZIP+4

310 CLOVERLEAF SQ STE A1, BIG STONE GAP, VA, 24219-3074

✓ 9-Digit EDI 837 ZIP+4 (24219-3074)

Practice Phone & Referral Fax

(276) 523-2100

Fax: (276) 523-2101

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1053901272 (MARK LEE BLANTON) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1053901272` (NPI-1 Individual Practitioner)
Provider / Legal Name	MARK LEE BLANTON
Plain-English Specialty	Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy NUCC Code: `3336C0003X` (Pharmacy, Community/Retail Pharmacy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	310 CLOVERLEAF SQ STE A1, BIG STONE GAP, VA, 24219-3074
Practice Telephone / Fax	Tel: (276) 523-2100 \| Fax: (276) 523-2101
Administrative Mailing Address	310 CLOVERLEAF SQ STE A1, BIG STONE GAP, VA, 24219-3074
Enumeration & Last Sync	Enumerated: 2021-01-21 \| CMS Record Updated: 2021-01-21

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

310 CLOVERLEAF SQ STE A1, BIG STONE GAP, VA, 24219-3074

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Plain-English Taxonomy & CMS Crosswalk (3336C0003X)

What Does Taxonomy Code 3336C0003X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3336C0003X translates to:
"Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code A5 (Pharmacy)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacy, Community/Retail Pharmacy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MARK LEE BLANTON)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`3336C0003X` — Pharmacy, Community/Retail Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy	State: VA \| License: `0202010024` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MARK LEE BLANTON (NPI #1053901272)