Blaylock Anesthesia Group
Organization Active NPI Contractor · Bridgeport, TX
NPI 1225347396 · NPPES record last updated Oct 6, 2010
Key facts
- NPI
- 1225347396
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Contractor 171W00000X
- License
- 227712 (TX)
- Legal business name
- BLAYLOCK ANESTHESIA GROUP
- Practice address
- 1905 Doctors Hospital Dr
Bridgeport, TX 76426-2260 - Phone
- (940) 683-0300
- NPI assigned
- Oct 6, 2010
- Organization subpart
- No
Authorized official
- Name
- Winnie C Blaylock, CRNA
- Title
- Sole Proprietor
- Phone
- (940) 683-0300
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor |
171W00000X | 227712 | TX | Yes |
Addresses
Primary practice location
1905 Doctors Hospital Dr
Bridgeport, TX 76426-2260
Mailing address
1905 Doctors Hospital Dr
Bridgeport, TX 76426-2260
Phone (940) 683-0300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007073201 | Medicaid | TX |
Other providers in Bridgeport, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.