Provider Demographics
NPI:1154374528
Name:BLUEBONNET DURABLE MEDICAL EQUIPMENT & SUPPLIES LLC
Entity type:Organization
Organization Name:BLUEBONNET DURABLE MEDICAL EQUIPMENT & SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DESI
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-849-1044
Mailing Address - Street 1:507 N GRANT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-5302
Mailing Address - Country:US
Mailing Address - Phone:956-849-1044
Mailing Address - Fax:956-849-7455
Practice Address - Street 1:507 N GRANT ST STE 1
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-5302
Practice Address - Country:US
Practice Address - Phone:956-849-1044
Practice Address - Fax:956-849-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0070690332BP3500X, 332BX2000X
TX0012948332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162723403Medicaid
TX162723404Medicaid
5504430001Medicare NSC