Organization
BLAKE SURGICAL ASSOCIATION PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER BLAKE M.D. (OWNER/PHYSICIAN)
(662) 846-8880
Entity
Organization
Contact information
Practice address
907 E SUNFLOWER RD #101, CLEVELAND, MS 38732-2833
(662) 846-8880
Mailing address
907 E SUNFLOWER RD, 101, CLEVELAND, MS 38732-2830
(662) 846-8880
(662) 846-8886
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
16881
MS
2086S0102X
Surgical Critical Care Physician
Primary
16881
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122620
—
MS
01
—
020000545
MEDICARE PROVIDER #
MS
01
—
C03406
MEDICARE GROUP #
MS
Enumeration date
07/24/2007
Last updated
08/30/2020
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us