| Bluestone Physician Services Southeast LLC | |
|
999 Waterside Dr Ste 2525 Norfolk VA 23510-3316 | |
| (757) 777-3433 | |
| (855) 818-3907 |
| Full Name | Bluestone Physician Services Southeast LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 999 Waterside Dr Ste 2525, Norfolk, Virginia |
| Authorized Official Name and Position | Tim Koehler (COO) |
| Authorized Official Contact | 6513421039 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluestone Physician Services Southeast LLC 270 Main St N Ste 300 Stillwater MN 55082-6788 Ph: (651) 342-1039 | Bluestone Physician Services Southeast LLC 999 Waterside Dr Ste 2525 Norfolk VA 23510-3316 Ph: (757) 777-3433 |
| NPI Number | 1255945739 |
|---|---|
| Provider Enumeration Date | 09/02/2020 |
| Last Update Date | 10/22/2020 |
| Certification Date | 10/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255945739 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| 208D00000X | General Practice | (NU) | Secondary |
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