Provider Demographics
NPI:1952658577
Name:BLUEBIRD MEDICAL SUPPLY COMPANY
Entity Type:Organization
Organization Name:BLUEBIRD MEDICAL SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MILICA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:406-585-2860
Mailing Address - Street 1:777 EAST MAIN STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3809
Mailing Address - Country:US
Mailing Address - Phone:406-585-2860
Mailing Address - Fax:406-586-9708
Practice Address - Street 1:777 EAST MAIN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3809
Practice Address - Country:US
Practice Address - Phone:406-585-2860
Practice Address - Fax:406-586-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MT13-00043496332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT6852710001Medicare NSC