1942430582 NPI number — BLUEBIRD MEDICAL ENTERPRISES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942430582 NPI number — BLUEBIRD MEDICAL ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUEBIRD MEDICAL ENTERPRISES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LONE STAR AIR RESCUE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942430582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 3000 PMB 155
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-771-1513
Provider Business Mailing Address Fax Number:
254-771-1181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
442 CHAMPIONS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78628-1199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-771-1513
Provider Business Practice Location Address Fax Number:
254-771-1181
Provider Enumeration Date:
07/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
254-771-1513

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  1000280 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000280 . This is a "TEXAS DEPT OF STATE HEALTH SERVICES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com