Healthcare Provider Details

I. General information

NPI: 1134537855
Provider Name (Legal Business Name): BLUE MARBLE MOBILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55285 HWY 17
SULLIGENT AL
35586
US

IV. Provider business mailing address

55285 HWY 17
SULLIGENT AL
35586
US

V. Phone/Fax

Practice location:
  • Phone: 662-646-0923
  • Fax:
Mailing address:
  • Phone: 662-646-0923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TRACY BRYANT
Title or Position: OWNER
Credential:
Phone: 662-646-0923