Bluejack Surgical Affiliates

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Legal business name

BLUEJACK SURGICAL AFFILIATES

Practice address

1202 E Arapaho Rd Ste 122
Richardson, TX 75081-2400

Phone

(469) 250-4422

Fax

(469) 250-7068

NPI assigned

Sep 10, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christopher John Brock

Title

Managing Partner

Phone

(972) 979-6222

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568073600000",
    "number": "1043869100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 E ARAPAHO RD STE 122",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750812400",
            "telephone_number": "469-250-4422",
            "fax_number": "469-250-7068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 E ARAPAHO RD STE 122",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750812400",
            "telephone_number": "469-250-4422",
            "fax_number": "469-250-7068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEJACK SURGICAL AFFILIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-10",
        "last_updated": "2019-09-10",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "972-979-6222"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Anne Bledsoe, OTR/L
• Roy William Bledsoe, DDS
• Blessing Patient Care Services, LLC
• Tamatha Blodgett, LPC
• BLSM Caretaking Company
• James Raymond Blum, D.C.,DIPL.AC
• Richard Fred Blume, DDS MS
• Bmdhealth TX
• Sharvil Boda, PHARMD
• David Jackson Bodie, DDS

• Surgical Physician Assistant in Richardson, TX
• Providers in Richardson, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.