Blaylock Anesthesia Group

Primary specialty

ContractorTaxonomy code 171W00000X

License

227712 Issued in 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

Last updated

Oct 6, 2010By 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

Winnie C Blaylock, CRNA

Title

Sole Proprietor

Phone

(940) 683-0300

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1286323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286323200000",
    "number": "1225347396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 DOCTORS HOSPITAL DR",
            "city": "BRIDGEPORT",
            "state": "TX",
            "postal_code": "764262260",
            "telephone_number": "940-683-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 DOCTORS HOSPITAL DR",
            "city": "BRIDGEPORT",
            "state": "TX",
            "postal_code": "764262260",
            "telephone_number": "940-683-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAYLOCK ANESTHESIA GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-06",
        "last_updated": "2010-10-06",
        "status": "A",
        "authorized_official_last_name": "BLAYLOCK",
        "authorized_official_first_name": "WINNIE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "940-683-0300",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "TX",
            "license": "227712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007073201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 34HHA, Inc (HomeHealth Care of North Central Texas, Inc)
• Janear Rochelle Anderson, M.D
• Apsp-Bridgeport, LLC
• Bay Roc Health Care Providers, LLC (Bridgeport Health Care Center)
• Dawn Denise Blevins, RD, LD
• Bridgeport Ambulatory Surgery Center
• Bridgeport Care Center, Inc (Bridgeport Care Center)
• Bridgeport Emergency Medicine Associates PA
• Bridgeport Essential Practices, LLC (Bridgeport Health Care Center)

• Contractor in Bridgeport, TX
• Providers in Bridgeport, TX by specialty
• Contractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.