Provider Demographics
NPI:1750074894
Name:FLORIDA BLUE MEDICARE INC
Entity type:Organization
Organization Name:FLORIDA BLUE MEDICARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MEDICARE CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-808-7542
Mailing Address - Street 1:4800 DEERWOOD CAMPUS PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8317
Mailing Address - Country:US
Mailing Address - Phone:904-791-6111
Mailing Address - Fax:
Practice Address - Street 1:4800 DEERWOOD CAMPUS PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8317
Practice Address - Country:US
Practice Address - Phone:904-791-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization