Healthcare Provider Details

I. General information

NPI: 1174573513
Provider Name (Legal Business Name): BLUEDOT MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 WHITEHALL PARK DR STE 200
CHARLOTTE NC
28273-3433
US

IV. Provider business mailing address

PO BOX 27968
SALT LAKE CITY UT
84127-0968
US

V. Phone/Fax

Practice location:
  • Phone: 704-344-0700
  • Fax: 704-344-0701
Mailing address:
  • Phone: 765-448-6685
  • Fax: 765-446-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0317348
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROBIN L MENCHEN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 407-822-4600