Provider Demographics
NPI:1689009698
Name:BLUE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:BLUE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YUSMIELYS
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-905-0925
Mailing Address - Street 1:7911 NW 72ND AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2223
Mailing Address - Country:US
Mailing Address - Phone:305-905-0925
Mailing Address - Fax:
Practice Address - Street 1:7911 NW 72ND AVE STE 215
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-2223
Practice Address - Country:US
Practice Address - Phone:305-905-0925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center