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General NPI Number Information
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NPI Number | 1639776172
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Entity Type | Organization
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Legal Business Name | BLUE DOT
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 370 ROBERTS ST
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City | MUSKEGON
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State | MI
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Zip | 49442-1363
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Country | US
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Telephone | 231-457-7408
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 103
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City | MUSKEGON
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State | MI
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Zip | 49443-0103
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Country | US
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Telephone | 231-457-7408
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHERRI BLACK
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Credential |
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Telephone | 231-457-7408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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