Organization
BLU BIRD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY PETERKIN CONGER (PRESIDENT)
(803) 874-4369
Entity
Organization
Contact information
Practice address
711 HARRY RAYSOR DR, SAINT MATTHEWS, SC 29135
(803) 874-4369
(803) 874-1772
Mailing address
711 HARRY RAYSOR DR, SAINT MATTHEWS, SC 29135
(803) 874-4369
(803) 874-1772
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
00071953
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DE1411
—
SC
Enumeration date
12/13/2006
Last updated
12/28/2007
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