# BLUESTONE PHYSICIAN SERVICES SOUTHEAST LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bluestone Physician Services Florida, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255945739
- **Authorized official:** TIM KOEHLER (COO)
- **Authorized official phone:** (651) 342-1039

## Contact information

- **Practice address:** 999 WATERSIDE DR STE 2525, NORFOLK, VA 23510-3316
- **Practice address phone:** (757) 777-3433
- **Practice address fax:** (855) 818-3907
- **Mailing address:** 270 MAIN ST N STE 300, STILLWATER, MN 55082-6788
- **Mailing address phone:** (651) 342-1039
- **Mailing address fax:** (651) 342-1428

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |

## Other

- **Enumeration date:** 09/02/2020
- **Last updated:** 10/22/2020