Provider Demographics
NPI:1851658439
Name:BLUEMEDLLC
Entity type:Organization
Organization Name:BLUEMEDLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBICHEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-896-2900
Mailing Address - Street 1:11504 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-6114
Mailing Address - Country:US
Mailing Address - Phone:228-861-6918
Mailing Address - Fax:228-896-4337
Practice Address - Street 1:76 48TH ST STE D
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-4029
Practice Address - Country:US
Practice Address - Phone:228-896-2900
Practice Address - Fax:228-896-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies