NPIMap

Organization Active NPI

Thomas R. Blackledge, Jr., MD, PA

  • Family Medicine Physician
  • Magee, MS
National Provider Identifier
1376861757
Registry record updated May 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14559 Issued in MS
Legal business name
THOMAS R. BLACKLEDGE, JR., MD, PA
Practice address
800 3Rd St SW
Magee, MS 39111-3951
Phone
(601) 849-1918
Fax
(601) 849-1908
NPI assigned
May 11, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2010

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

Authorized official

Name
Thomas R. Blackledge Jr., M.D.
Title
MD/Owner
Phone
(601) 849-1918

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 14559 MS Primary

Addresses

Primary practice location

800 3Rd St SW
Magee, MS 39111-3951

Mailing address

PO Box 748
Magee, MS 39111-0748
Phone (601) 849-1918

Other identifiers 1

IdentifierTypeStateIssuer
00115523MedicaidMS

Other names 1

  • Medical Center of Magee Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

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": "1273536000000",
    "number": "1376861757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391110748",
            "telephone_number": "601-849-1918",
            "fax_number": "601-849-1908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 3RD ST SW",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391113951",
            "telephone_number": "601-849-1918",
            "fax_number": "601-849-1908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS R. BLACKLEDGE, JR., MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-11",
        "last_updated": "2010-05-11",
        "status": "A",
        "authorized_official_last_name": "BLACKLEDGE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "601-849-1918",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "14559",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00115523",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Center of Magee",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Magee, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.