Healthcare Provider Details

I. General information

NPI: 1649499690
Provider Name (Legal Business Name): SKY PROSTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 CHIEF ST
BENKELMAN NE
69021-3065
US

IV. Provider business mailing address

503 CHIEF ST
BENKELMAN NE
69021-3065
US

V. Phone/Fax

Practice location:
  • Phone: 308-423-2690
  • Fax: 308-423-2691
Mailing address:
  • Phone: 308-423-2690
  • Fax: 308-423-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCPO 2571
License Number StateVA

VIII. Authorized Official

Name: BENJAMIN WAYNE BLECHA
Title or Position: OWNER PRESIDENT
Credential: C.P.O.
Phone: 308-423-2690