Provider Demographics
NPI:1992245674
Name:BLUE START GROUP
Entity type:Organization
Organization Name:BLUE START GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-777-9872
Mailing Address - Street 1:2820 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-1800
Mailing Address - Country:US
Mailing Address - Phone:361-777-9872
Mailing Address - Fax:
Practice Address - Street 1:2820 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 215
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-1800
Practice Address - Country:US
Practice Address - Phone:361-777-9872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5286111OtherID