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Organization
BLUESTONE PHYSICIAN SERVICES SOUTHEAST LLC
Active
Organization
BLUESTONE PHYSICIAN SERVICES SOUTHEAST LLC
Active
Other names
Bluestone Physician Services Florida, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TIM KOEHLER (COO)
(651) 342-1039
Entity
Organization
Contact information
Practice address
999 WATERSIDE DR STE 2525, NORFOLK, VA 23510-3316
(757) 777-3433
(855) 818-3907
Mailing address
270 MAIN ST N STE 300, STILLWATER, MN 55082-6788
(651) 342-1039
(651) 342-1428
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
Other
Enumeration date
09/02/2020
Last updated
10/22/2020
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