Provider Demographics
NPI:1073002069
Name:BLUEBIRD MOBILITY
Entity Type:Organization
Organization Name:BLUEBIRD MOBILITY
Other - Org Name:BLUEBIRD MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-560-9563
Mailing Address - Street 1:3252 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7428
Mailing Address - Country:US
Mailing Address - Phone:239-790-4201
Mailing Address - Fax:
Practice Address - Street 1:3252 PALM AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7428
Practice Address - Country:US
Practice Address - Phone:239-790-4201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUEBIRD TAXI OF LEE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)