MEDICARE: BLUEBIRD MEDICAL SUPPLY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		NV

General Provider Information

NPI Number	:	1023404241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEBIRD MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	1400 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8511
Country	:	US
Telephone Number	:	702-998-1438
Fax Number	:	702-998-0249

Provider Business Practice Location Address
First Line	:	1400 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8511
Country	:	US
Telephone Number	:	702-998-1438
Fax Number	:	702-998-0249

Authorized Official
Title or Position	:	OWNER
Name	:	KARINE GHADYAN
Credential	:
Telephone Number	:	702-469-6173

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	07/21/2022

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