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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

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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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