Organization
BLAYLOCK ANESTHESIA GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WINNIE C BLAYLOCK CRNA (SOLE PROPRIETOR)
(940) 683-0300
Entity
Organization
Contact information
Practice address
1905 DOCTORS HOSPITAL DR, BRIDGEPORT, TX 76426-2260
(940) 683-0300
Mailing address
1905 DOCTORS HOSPITAL DR, BRIDGEPORT, TX 76426-2260
(940) 683-0300
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
227712
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007073201
—
TX
Enumeration date
10/06/2010
Last updated
10/06/2010
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