| 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 | Yes. This clinic participates in medicare program and accept medicare insurance. |
| 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 |
| Medicare PECOS PAC ID | 9739086257 |
|---|---|
| Medicare Enrollment ID | O20201202001384 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255945739 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| Provider Name | Jason Evers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235506387 PECOS PAC ID: 4587913751 Enrollment ID: I20201130003036 |
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