| Blueshine Medical Center Llc | |
|
140 Santa Barbara Blvd Ste 121 Cape Coral FL 33991-2160 | |
| (305) 790-6544 | |
| Not Available |
| Full Name | Blueshine Medical Center Llc |
|---|---|
| Speciality | General Practice |
| Location | 140 Santa Barbara Blvd Ste 121, Cape Coral, Florida |
| Authorized Official Name and Position | Jose Gustavo Cevallos (PROVIDER) |
| Authorized Official Contact | 3057906544 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blueshine Medical Center Llc 205 Nw 15th Pl Cape Coral FL 33993-7747 Ph: (561) 762-1660 | Blueshine Medical Center Llc 140 Santa Barbara Blvd Ste 121 Cape Coral FL 33991-2160 Ph: (305) 790-6544 |
| NPI Number | 1053138099 |
|---|---|
| Provider Enumeration Date | 09/23/2024 |
| Last Update Date | 09/23/2024 |
| Medicare PECOS PAC ID | 6608391222 |
|---|---|
| Medicare Enrollment ID | O20250416001777 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053138099 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Jose G Cevallos Yepez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922236736 PECOS PAC ID: 7719112382 Enrollment ID: I20131107000497 |
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