Provider Demographics
NPI:1124818729
Name:BLUE MEDICAL LLC
Entity type:Organization
Organization Name:BLUE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:SHEFULSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-444-3501
Mailing Address - Street 1:4319 S NATIONAL AVE # 309
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2607
Mailing Address - Country:US
Mailing Address - Phone:417-444-3501
Mailing Address - Fax:
Practice Address - Street 1:1029 W BATTLEFIELD ST APT E312
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4384
Practice Address - Country:US
Practice Address - Phone:417-444-3501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty