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General NPI Number Information
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NPI Number | 1942430582
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Entity Type | Organization
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Legal Business Name | BLUEBIRD MEDICAL ENTERPRISES
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 442 CHAMPIONS DR
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City | GEORGETOWN
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State | TX
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Zip | 78628-1199
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Country | US
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Telephone | 254-771-1513
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Fax | 254-771-1181
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Provider Business Mailing Address
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Address Line | P O BOX 3000 PMB 155
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City | GEORGETOWN
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State | TX
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Zip | 78627
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Country | US
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Telephone | 254-771-1513
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Fax | 254-771-1181
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID PHILLIPS
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Credential |
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Telephone | 254-771-1513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416A0800X
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Taxonomy Name | Air Ambulance
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License Number | 1000280
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License Number State | TX
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