Provider Demographics
NPI:1942430582
Name:BLUEBIRD MEDICAL ENTERPRISES
Entity Type:Organization
Organization Name:BLUEBIRD MEDICAL ENTERPRISES
Other - Org Name:LONE STAR AIR RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-771-1513
Mailing Address - Street 1:P O BOX 3000 PMB 155
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627
Mailing Address - Country:US
Mailing Address - Phone:254-771-1513
Mailing Address - Fax:254-771-1181
Practice Address - Street 1:442 CHAMPIONS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1199
Practice Address - Country:US
Practice Address - Phone:254-771-1513
Practice Address - Fax:254-771-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10002803416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1000280OtherTEXAS DEPT OF STATE HEALTH SERVICES