Provider Demographics
NPI:1104666197
Name:BLUE MEDICAL INC
Entity type:Organization
Organization Name:BLUE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICKSON
Authorized Official - Middle Name:ANGEN
Authorized Official - Last Name:BALDERA GARCES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-993-1475
Mailing Address - Street 1:4651 GREEN PALM LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-5991
Mailing Address - Country:US
Mailing Address - Phone:201-993-1475
Mailing Address - Fax:
Practice Address - Street 1:4651 GREEN PALM LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5991
Practice Address - Country:US
Practice Address - Phone:201-993-1475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care