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General NPI Number Information
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NPI Number | 1689745382
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Entity Type | Organization
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Legal Business Name | BLAKE IMAGING LLC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2010 59TH STREET WEST STUIE 1500
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City | BRADENTON
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State | FL
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Zip | 34209
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Country | US
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Telephone | 941-792-2288
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Fax | 941-798-2197
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Provider Business Mailing Address
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Address Line | 122 LINSLEY AVE SUITE A
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 813-657-4914
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Fax | 813-657-4916
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. ROBERT SAMUEL HANKINS JR.
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Credential |
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Telephone | 615-344-2274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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