Provider Demographics
NPI:1750748547
Name:BLUE DOT MEDICAL, INC
Entity type:Organization
Organization Name:BLUE DOT MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-968-0981
Mailing Address - Street 1:2301 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9549
Mailing Address - Country:US
Mailing Address - Phone:601-968-0981
Mailing Address - Fax:601-968-0983
Practice Address - Street 1:1827D SIMPSON HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-3439
Practice Address - Country:US
Practice Address - Phone:601-968-0981
Practice Address - Fax:601-968-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05646/11.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS440981Medicaid
MS=========OtherSTATE HEALTH PLAN / BLUE CROSS BLUE SHIELD MISSISSIPPI
MS=========OtherBLUE CROSS BLUE SHIELD - MISSISSIPPI
MS4514950001Medicare NSC