MEDICARE: BLUE SKY TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1629754635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE SKY TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	921 W LAPHAM BLVD APT 12
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3435
Country	:	US
Telephone Number	:	414-422-5598
Fax Number	:

Provider Business Practice Location Address
First Line	:	921 W LAPHAM BLVD APT 12
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3435
Country	:	US
Telephone Number	:	414-422-5598
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS NAJAH HUSSEIN ABDI
Credential	:
Telephone Number	:	414-422-5598

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	06/26/2023

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