MEDICARE: BLUE STAR 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

General Provider Information

NPI Number	:	1760195390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE STAR MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	4701 N FEDERAL HWY STE 324
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 N FEDERAL HWY STE 324
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6563
Country	:	US
Telephone Number	:	954-488-4907
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RYAN GREENE
Credential	:
Telephone Number	:	954-488-4907

Provider Enumeration Date	:	12/28/2022
Last Update Date	:	12/28/2022

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