| Blossomwood Medical Pc | |
|
2121 Whitesburg Dr Se Suite C Huntsville AL 35801-4501 | |
| (256) 883-0107 | |
| (256) 883-0207 |
| Full Name | Blossomwood Medical Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2121 Whitesburg Dr Se, Huntsville, Alabama |
| Authorized Official Name and Position | Vytautas Pukis (PHYSICIAN) |
| Authorized Official Contact | 2564319257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blossomwood Medical Pc 2121 Whitesburg Dr Se Suite C Huntsville AL 35801-4501 Ph: (256) 883-0107 | Blossomwood Medical Pc 2121 Whitesburg Dr Se Suite C Huntsville AL 35801-4501 Ph: (256) 883-0107 |
| NPI Number | 1144451311 |
|---|---|
| Provider Enumeration Date | 08/05/2009 |
| Last Update Date | 02/04/2013 |
| Medicare PECOS PAC ID | 4183770118 |
|---|---|
| Medicare Enrollment ID | O20090916000637 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144451311 | NPI | - | NPPES |
| 113285 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD29689 (Alabama) | Primary |
| Provider Name | Vytautas Pukis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225270440 PECOS PAC ID: 5294881223 Enrollment ID: I20090916000613 |
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