Provider Demographics
NPI:1588823389
Name:BLUE OCEAN HEALTHCARE PHYSICIANS GROUP
Entity type:Organization
Organization Name:BLUE OCEAN HEALTHCARE PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:SHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-743-3311
Mailing Address - Street 1:21300 GERTRUDE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5018
Mailing Address - Country:US
Mailing Address - Phone:941-743-3311
Mailing Address - Fax:941-743-3313
Practice Address - Street 1:21300 GERTRUDE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5018
Practice Address - Country:US
Practice Address - Phone:941-743-3311
Practice Address - Fax:941-743-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38218OtherBCBS FL
FLDN4325OtherRAILROAD MEDICARE
FLDN4325OtherRAILROAD MEDICARE
FL38218OtherBCBS FL