Provider Demographics
NPI:1174573513
Name:BLUEDOT MEDICAL INC
Entity type:Organization
Organization Name:BLUEDOT MEDICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MENCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-822-4600
Mailing Address - Street 1:PO BOX 27968
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0968
Mailing Address - Country:US
Mailing Address - Phone:765-448-6685
Mailing Address - Fax:765-446-4287
Practice Address - Street 1:2915 WHITEHALL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3433
Practice Address - Country:US
Practice Address - Phone:704-344-0700
Practice Address - Fax:704-344-0701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROTECH HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-10
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X, 332BC3200X, 332BP3500X, 332BX2000X
NC0317348332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703755Medicaid
NC4616100001Medicare NSC