MEDICARE: BLUEBIRD MOBILITY

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1073002069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEBIRD MOBILITY

Provider Business Mailing Address
First Line	:	3252 PALM AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-7428
Country	:	US
Telephone Number	:	239-790-4201
Fax Number	:

Provider Business Practice Location Address
First Line	:	3252 PALM AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-7428
Country	:	US
Telephone Number	:	239-790-4201
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MICHAEL GRIFFIN
Credential	:
Telephone Number	:	239-560-9563

Provider Enumeration Date	:	05/04/2018
Last Update Date	:	05/04/2018

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