Basic Information
| Provider Information | |||||||||
| NPI: | 1508817172 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLAKE IMAGING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 59TH ST W | ||||||||
| Address2: | SUITE 1500 | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342094616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417926611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2010 59TH ST W | ||||||||
| Address2: | SUITE 1500 | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342094616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417926611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HANKINS | ||||||||
| AuthorizedOfficialFirstName: | SAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6153442274 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.