Provider Demographics
NPI:1780418780
Name:BLUEWAVE SUPPLIES LLC
Entity type:Organization
Organization Name:BLUEWAVE SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN SWELM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-382-0132
Mailing Address - Street 1:223 W ANDERSON LN STE B202
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1135
Mailing Address - Country:US
Mailing Address - Phone:512-382-0132
Mailing Address - Fax:737-381-1177
Practice Address - Street 1:223 W ANDERSON LN STE B202
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1135
Practice Address - Country:US
Practice Address - Phone:512-382-0132
Practice Address - Fax:737-381-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies