MEDICARE: BLAKE IMAGING, LLC

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
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1508817172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLAKE IMAGING, LLC

Provider Business Mailing Address
First Line	:	2010 59TH ST W
Second Line	:	SUITE 1500
City	:	BRADENTON
State	:	FL
Zip	:	34209-4616
Country	:	US
Telephone Number	:	941-792-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 59TH ST W
Second Line	:	SUITE 1500
City	:	BRADENTON
State	:	FL
Zip	:	34209-4616
Country	:	US
Telephone Number	:	941-792-6611
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	SAM HANKINS
Credential	:
Telephone Number	:	615-344-2274

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	08/22/2020

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