Provider Demographics
NPI:1992349823
Name:BLASICK ORTHOPEDICS, PLLC
Entity type:Organization
Organization Name:BLASICK ORTHOPEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLASICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-224-8062
Mailing Address - Street 1:PO BOX 26069
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2011
Mailing Address - Country:US
Mailing Address - Phone:254-224-8062
Mailing Address - Fax:254-224-6385
Practice Address - Street 1:7005 WOODWAY DR STE 101
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-6160
Practice Address - Country:US
Practice Address - Phone:254-224-8062
Practice Address - Fax:254-224-6385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLASICK ORTHOPEDICS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-04
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty