10D2202148 CLIA NUMBER - BLUETAIL MEDICAL GROUP, LLC

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Laboratory Demographics

CLIA Number: 10D2202148

Facility Name: BLUETAIL MEDICAL GROUP, LLC

Facility Address:
1875 VETERANS PARK DRIVE, SUITE #2201
NAPLES, FL
ZIP 34109
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Facility Phone Number: 239 631-1960

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1285986398

Taxonomy: 207XX0005X - Orthopaedic Surgery
An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries.

CLIA Record

Field Name	Field Value
CLIA Number	10D2202148
LAB Type	Physician Office
Facility Name	BLUETAIL MEDICAL GROUP, LLC
Street	1875 VETERANS PARK DRIVE, SUITE #2201
City	NAPLES
State	FL
ZIP	34109
Phone	239 631-1960
CertificateType	4
CertificateEffectiveDate	11/25/2022
CertificateExpirationDate	11/24/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024