NPIMap

Organization Active NPI

Blaine Randall Blakestad MD PA

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Lufkin, TX
National Provider Identifier
1124346598
Registry record updated Sep 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X
License
F1391 Issued in TX
Legal business name
BLAINE RANDALL BLAKESTAD MD PA
Practice address
1201 W Frank Ave
Lufkin, TX 75904-3357
Phone
(936) 634-8111
NPI assigned
May 11, 2010
Last updated
Sep 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2010

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

Authorized official

Name
Dr. Blaine Randall Blakestad, MDNPI 1881641975
Title
President
Phone
(936) 632-5894

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0011X F1391 TX Primary

Addresses

Primary practice location

1201 W Frank Ave
Lufkin, TX 75904-3357

Mailing address

702 Brentwood Dr
Lufkin, TX 75901-8853
Phone (936) 632-5894

National Provider Directory

National Provider Directory

Locations

121 Gaslight Medical Pkwy
Ste 102
Lufkin, TX 75904
Phone (936) 632-2220

1023 N Mound St
Ste C
Nacogdoches, TX 75961
Phone (409) 634-4222

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1273536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283990400000",
    "number": "1124346598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 BRENTWOOD DR",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759018853",
            "telephone_number": "936-632-5894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 W FRANK AVE",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759043357",
            "telephone_number": "936-634-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAINE RANDALL BLAKESTAD MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-11",
        "last_updated": "2010-09-09",
        "status": "A",
        "authorized_official_last_name": "BLAKESTAD",
        "authorized_official_first_name": "BLAINE",
        "authorized_official_middle_name": "RANDALL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "936-632-5894",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2083P0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "TX",
            "license": "F1391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lufkin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2010; 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.