Blake Pain Solutions PC

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

License

MD60071790 Issued in WA

Legal business name

BLAKE PAIN SOLUTIONS PC

Practice address

2312 NE 129TH St
Vancouver, WA 98686-3236

Phone

(360) 696-5022

Fax

(360) 696-5445

NPI assigned

Jan 26, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Jacob Leroy Blake, MD

Title

Ceo/Physician

Phone

(503) 894-0365

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1327536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332115200000",
    "number": "1063784700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1600",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986681600",
            "telephone_number": "360-696-5022",
            "fax_number": "360-696-5445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2312 NE 129TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986863236",
            "telephone_number": "360-696-5022",
            "fax_number": "360-696-5445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAKE PAIN SOLUTIONS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-26",
        "last_updated": "2012-03-19",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "LEROY",
        "authorized_official_title_or_position": "CEO/PHYSICIAN",
        "authorized_official_telephone_number": "503-894-0365",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "WA",
            "license": "MD60071790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8537383",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevoy Blackwood
• Kabiah Ann Blain
• Jackie Hyman Blair, MED.,CDP
• Rebecca Kaye Blair, LICWSA
• Victoria T Blaj
• Anne E Blake-Nickels, BS, BA, AAC
• Alexandria Nicole Blake
• Hannah M Blake, SLP-A
• Belinda Blakeley
• Austin Blakeslee, PHARMD

• Pain Clinic/Center in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Pain Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2012; 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.