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NPI Code Detail

MEDICARE: BLUESTONE PHYSICIAN SERVICES SOUTHEAST LLC

MEDICARE: BLUESTONE PHYSICIAN SERVICES SOUTHEAST LLC
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

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3CK5239OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
234388OTHERFLBC/BS

General Provider Information

NPI Number : 1346212370
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUESTONE PHYSICIAN SERVICES SOUTHEAST LLC
Provider Business Mailing Address
First Line : 10150 HIGHLAND MANOR DR STE 205
Second Line :
City : TAMPA
State : FL
Zip : 33610-9727
Country : US
Telephone Number : 813-259-1013
Fax Number : 813-254-0396
Provider Business Practice Location Address
First Line : 10150 HIGHLAND MANOR DR STE 205
Second Line :
City : TAMPA
State : FL
Zip : 33610-9727
Country : US
Telephone Number : 813-259-1013
Fax Number : 813-254-0396
Authorized Official
Title or Position : OFFICE MANAGER
Name : DIANA BERNARD I
Credential :
Telephone Number : 813-259-1013
Provider Enumeration Date : 02/03/2006
Last Update Date : 02/07/2024

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Directions to “BLUESTONE PHYSICIAN SERVICES SOUTHEAST LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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