Provider Demographics
NPI:1508817172
Name:BLAKE IMAGING, LLC
Entity Type:Organization
Organization Name:BLAKE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-344-2274
Mailing Address - Street 1:2010 59TH ST W
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4616
Mailing Address - Country:US
Mailing Address - Phone:941-792-6611
Mailing Address - Fax:
Practice Address - Street 1:2010 59TH ST W
Practice Address - Street 2:SUITE 1500
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4616
Practice Address - Country:US
Practice Address - Phone:941-792-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty