Healthcare Provider Details

I. General information

NPI: 1104619139
Provider Name (Legal Business Name): BLUEBONNET MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MERCEDES LN
KYLE TX
78640-5187
US

IV. Provider business mailing address

19500 INTERSTATE 35 APT 1150
KYLE TX
78640-3745
US

V. Phone/Fax

Practice location:
  • Phone: 512-767-0743
  • Fax:
Mailing address:
  • Phone: 512-767-0743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. SERGIO RICARDO SANCHEZ RODRIGUEZ
Title or Position: FOUNDER/CEO
Credential: AEMT
Phone: 512-767-0743