Healthcare Provider Details

I. General information

NPI: 1942557434
Provider Name (Legal Business Name): BLUE SKIES HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HORSESHOE DR APT A
DEMING NM
88030-5246
US

IV. Provider business mailing address

400 HORSESHOE DR APT A
DEMING NM
88030-5246
US

V. Phone/Fax

Practice location:
  • Phone: 575-544-7387
  • Fax:
Mailing address:
  • Phone: 575-544-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. OWEN OSWALD O'CONNOR SR.
Title or Position: OWNER
Credential:
Phone: 575-544-7387