Blackbird Clinical Services, LLC

Primary specialty

Public Health or Welfare AgencyTaxonomy code 251K00000X

Legal business name

BLACKBIRD CLINICAL SERVICES, LLC

Practice address

2 Executive Dr Ste D
Lafayette, IN 47905-4878

Phone

(765) 447-8700

NPI assigned

Jan 12, 2009

Last updated

Jan 12, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kimi L. Hathaway

Title

President/ Ceo

Phone

(765) 447-8700

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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.

• Luella Bangura, MD

  • Internal Medicine Physician
  • Lafayette, IN
  • NPI 1720094584
  NPD (past)

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

{
    "created_epoch": "1231718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231718400000",
    "number": "1164669255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 EXECUTIVE DR STE D",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054878",
            "telephone_number": "765-447-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 EXECUTIVE DR STE D",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054878",
            "telephone_number": "765-447-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKBIRD CLINICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-12",
        "last_updated": "2009-01-12",
        "status": "A",
        "authorized_official_last_name": "HATHAWAY",
        "authorized_official_first_name": "KIMI",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT/ CEO",
        "authorized_official_telephone_number": "765-447-8700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brigitta Bittner, MD
• Hartmuth Bruno Bittner, M.D.
• BKD Productions, LLC (It's More to Your Door)
• BKD Productions, LLC (It's More to Your Door)
• Buck J Black, MSW, LCSW
• Holen Blackburn
• Susan Lynne Blakemore, FNP
• Annalise Bland, RBT
• John William Blank, MPT
• Mallory C Blankenberger, PA-C

• Public Health or Welfare Agency in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Public Health or Welfare Agency in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.