Healthcare Provider Details

I. General information

NPI: 1770210742
Provider Name (Legal Business Name): BLUE CAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 TURNER ST APT 2
AUBURN ME
04210-6076
US

IV. Provider business mailing address

252 TURNER ST APT 2
AUBURN ME
04210-6076
US

V. Phone/Fax

Practice location:
  • Phone: 682-256-6162
  • Fax:
Mailing address:
  • Phone: 682-256-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: RECOIT MBEMBO BASALA
Title or Position: MANAGER
Credential:
Phone: 682-256-6162