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General NPI Number Information
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NPI Number | 1811487804
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Entity Type | Organization
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Legal Business Name | BLUE RAY LLC
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 4345 STEINBECK WAY
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City | AVE MARIA
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State | FL
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Zip | 34142-5011
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Country | US
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Telephone | 239-244-1228
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Fax |
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Provider Business Mailing Address
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Address Line | 4345 STEINBECK WAY
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City | AVE MARIA
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State | FL
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Zip | 34142-5011
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Country | US
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Telephone | 239-244-1228
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER/DRIVER
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Name | GEORGE C JAGER
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Credential | BA
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Telephone | 239-244-1228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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