Provider Demographics
NPI:1790960615
Name:BLUE SPARROW CORPORATION
Entity Type:Organization
Organization Name:BLUE SPARROW CORPORATION
Other - Org Name:CORE MEDIA SOLUTIONS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BAPI
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOHANTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-772-1203
Mailing Address - Street 1:1475 S STATE COLLEGE BLVD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5701
Mailing Address - Country:US
Mailing Address - Phone:714-772-1203
Mailing Address - Fax:714-772-1213
Practice Address - Street 1:1475 S STATE COLLEGE BLVD
Practice Address - Street 2:SUITE 222
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5701
Practice Address - Country:US
Practice Address - Phone:714-772-1203
Practice Address - Fax:714-772-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies