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NPI Code Detail

MEDICARE: BLUESTAR CMB INCORPORATED

MEDICARE: BLUESTAR CMB INCORPORATED
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
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1710462676
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUESTAR CMB INCORPORATED
Provider Business Mailing Address
First Line : 2316 NW 23RD ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73107-2406
Country : US
Telephone Number : 405-408-3034
Fax Number : 405-525-3360
Provider Business Practice Location Address
First Line : 2316 NW 23RD ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73107-2406
Country : US
Telephone Number : 405-408-3034
Fax Number : 405-525-3360
Authorized Official
Title or Position : DIRECTOR
Name : CARRIE LYNN BUCKLEY
Credential :
Telephone Number : 405-408-3034
Provider Enumeration Date : 09/26/2018
Last Update Date : 09/26/2018

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Directions to “BLUESTAR CMB INCORPORATED ” Practice Location

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