Provider Demographics
NPI:1922014240
Name:BLUE STEM CARDIOLOGY PC
Entity Type:Organization
Organization Name:BLUE STEM CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-331-2577
Mailing Address - Street 1:3400 SE FRANK PHILLIPS
Mailing Address - Street 2:# 502
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006
Mailing Address - Country:US
Mailing Address - Phone:918-331-2577
Mailing Address - Fax:918-331-2513
Practice Address - Street 1:3400 SE FRANK PHILLIPS
Practice Address - Street 2:# 502
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006
Practice Address - Country:US
Practice Address - Phone:918-331-2577
Practice Address - Fax:918-331-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100749340AMedicaid
OK800522048Medicare ID - Type Unspecified
GACJ9145Medicare PIN
KS110751Medicare PIN