| J Waid Blackstone, M.d., Llc | |
|
210 W Spring St Sylacauga AL 35150-2924 | |
| (256) 245-5203 | |
| (256) 245-5981 |
| Full Name | J Waid Blackstone, M.d., Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 210 W Spring St, Sylacauga, Alabama |
| Authorized Official Name and Position | James Waid Blackstone (OWNER) |
| Authorized Official Contact | 2562455203 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J Waid Blackstone, M.d., Llc 210 W Spring St Sylacauga AL 35150-2924 Ph: (256) 245-5203 | J Waid Blackstone, M.d., Llc 210 W Spring St Sylacauga AL 35150-2924 Ph: (256) 245-5203 |
| NPI Number | 1285843888 |
|---|---|
| Provider Enumeration Date | 05/21/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0345281531 |
|---|---|
| Medicare Enrollment ID | O20050518000482 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285843888 | NPI | - | NPPES |
| 7514689 | Other | AL | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 24790 (Alabama) | Primary |
| Provider Name | James W Blackstone |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1477523090 PECOS PAC ID: 0244271435 Enrollment ID: I20050518000518 |
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