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
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
09/02/2020
Last updated
10/22/2020
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