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Walter Lee Blackburn

Anesthesiology

Allopathic & Osteopathic Physicians

3315 Watt Ave, Sacramento, CA 95821-3600

PECOS Enrollment

This provider is enrolled in PECOS as WALTER BLACKBURN.

Based on the most recent information from CMS, provider Walter Lee Blackburn is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1457738494
Provider Type
Individual
Full Name
Blackburn, Walter Lee
Credential
D.O.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
4/29/2015
Last Updated
8/29/2024

Contact Information

Practice Location

3315 Watt Ave, Sacramento, CA 95821-3600

(916) 481-6800

(916) 481-1881

Mailing Location

PO Box 1705, Medford, OR 97501-0132

(541) 773-7273

(541) 773-2027

Provider Taxonomies

Code	Description	License
Code 207L00000X Primary	Description Anesthesiology Allopathic & Osteopathic Physicians	License 20A19254 California

Walter Lee Blackburn

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Bahre, Bonita Marie

Wright, Richard Gordon

Lu, Vinh

Scheller, James G

Moore, Patrick A

Kuiken, Daniel Allen

Annette A Keochekian Md Inc

Weidoff, Paul M

Gunz, Edward F

Wagner, Brian Lee