Healthcare Provider Details

I. General information

NPI: 1215399183
Provider Name (Legal Business Name): BLAKE JAMES WEBB BCHIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 DEWAR DR STE 143
ROCK SPRINGS WY
82901-5815
US

IV. Provider business mailing address

6576 S 1615 E
MURRAY UT
84121-2521
US

V. Phone/Fax

Practice location:
  • Phone: 307-362-2662
  • Fax:
Mailing address:
  • Phone: 801-631-8436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: