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NPI Code Detail

MEDICARE: BLAKE M HODGES MD

MEDICARE: BLAKE M HODGES MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician35680SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1423971OTHERSCMEDICARE GROUP PTAN
23255OTHERSCMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659710440
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE M HODGES MD
Provider Business Mailing Address
First Line : PO BOX 968
Second Line :
City : ABBEVILLE
State : SC
Zip : 29620-0968
Country : US
Telephone Number : 864-366-5011
Fax Number :
Provider Business Practice Location Address
First Line : 901 W GREENWOOD ST STE 1
Second Line :
City : ABBEVILLE
State : SC
Zip : 29620-5727
Country : US
Telephone Number : 864-366-9681
Fax Number : 864-366-5600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2013
Last Update Date : 01/06/2023

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