| Blake Family Medicine Pllc | |
|
4704 Main St Shallotte NC 28470-1880 | |
| (910) 754-4545 | |
| (910) 754-4794 |
| Full Name | Blake Family Medicine Pllc |
|---|---|
| Speciality | Physician Assistant |
| Location | 4704 Main St, Shallotte, North Carolina |
| Authorized Official Name and Position | John A Blake (OWNER) |
| Authorized Official Contact | 9107544545 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blake Family Medicine Pllc Po Box 3206 Shallotte NC 28459-3206 Ph: (910) 754-4545 | Blake Family Medicine Pllc 4704 Main St Shallotte NC 28470-1880 Ph: (910) 754-4545 |
| NPI Number | 1295959310 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295959310 | NPI | - | NPPES |
| 5902868 | Medicaid | NC | |
| 017W4 | Other | NC | BCBS GRP |
| 55210 | Other | NC | BCBS |
| 185616 | Other | NC | MEDCOST |
| 858799 | Other | NC | UHC |
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