Healthcare Provider Details

I. General information

NPI: 1033403266
Provider Name (Legal Business Name): BLUE SKY, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N KING ST STE A
HENDERSONVILLE NC
28792-4349
US

IV. Provider business mailing address

PO BOX 360
SYLVA NC
28779-0360
US

V. Phone/Fax

Practice location:
  • Phone: 828-693-9199
  • Fax: 828-692-2487
Mailing address:
  • Phone: 828-587-6312
  • Fax: 828-586-8209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number200400137
License Number StateNC

VIII. Authorized Official

Name: RUTH E MARTIKAINEN
Title or Position: BILLING DIRECTOR
Credential:
Phone: 828-586-8160