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NPI Code Detail

MEDICARE: BLUESTEM MEDICAL, LLP

MEDICARE: BLUESTEM MEDICAL, LLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1110787OTHERKSBCBS

General Provider Information

NPI Number : 1265485403
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUESTEM MEDICAL, LLP
Provider Business Mailing Address
First Line : 501 GARFIELD ST
Second Line :
City : QUINTER
State : KS
Zip : 67752-9795
Country : US
Telephone Number : 785-754-3333
Fax Number : 785-754-2335
Provider Business Practice Location Address
First Line : 501 GARFIELD ST
Second Line :
City : QUINTER
State : KS
Zip : 67752-9795
Country : US
Telephone Number : 785-754-3333
Fax Number : 785-754-2335
Authorized Official
Title or Position : MANAGING PARTNER
Name : MICHAEL E MACHEN
Credential : MD
Telephone Number : 785-754-3333
Provider Enumeration Date : 05/18/2006
Last Update Date : 08/22/2020

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