Provider Demographics
NPI:1992419204
Name:BLAKES, IRVING J
Entity type:Individual
Prefix:
First Name:IRVING
Middle Name:J
Last Name:BLAKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ICARE
Other - Middle Name:TRANSPORTATION
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLC
Mailing Address - Street 1:275 PINECREST CIR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7935
Mailing Address - Country:US
Mailing Address - Phone:843-263-1053
Mailing Address - Fax:
Practice Address - Street 1:275 PINECREST CIR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7935
Practice Address - Country:US
Practice Address - Phone:843-263-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9742342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company