=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659268472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CODE BLUE MEDICAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2025
-----------------------------------------------------
Last Update Date | 06/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16922 TELGE RD STE 2D
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-1108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-677-9117
-----------------------------------------------------
Fax | 513-677-0045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 87 E US HIGHWAY 22 AND 3 STE 800
-----------------------------------------------------
City | MAINEVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45039-7843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-677-9117
-----------------------------------------------------
Fax | 513-677-0045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | WILLIAM ROBERT DANKO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 513-677-9117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------