Provider Demographics
NPI:1790193571
Name:BLUE MARBLE MOBILITY, LLC
Entity Type:Organization
Organization Name:BLUE MARBLE MOBILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-646-0923
Mailing Address - Street 1:516 LINCOLN RD
Mailing Address - Street 2:B
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2226
Mailing Address - Country:US
Mailing Address - Phone:662-241-7175
Mailing Address - Fax:
Practice Address - Street 1:516 LINCOLN RD
Practice Address - Street 2:B
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2226
Practice Address - Country:US
Practice Address - Phone:662-241-7175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies