Provider Demographics
NPI:1255601779
Name:BLUE SHIELD MEDICAL SUPPLIES & TRANSPORTATION, INC
Entity type:Organization
Organization Name:BLUE SHIELD MEDICAL SUPPLIES & TRANSPORTATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:T
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-788-3889
Mailing Address - Street 1:22239 KATY FWY
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1741
Mailing Address - Country:US
Mailing Address - Phone:281-788-3889
Mailing Address - Fax:
Practice Address - Street 1:22239 KATY FWY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1741
Practice Address - Country:US
Practice Address - Phone:281-788-3889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies