Healthcare Provider Details

I. General information

NPI: 1265928790
Provider Name (Legal Business Name): BLUE SKY LOGISTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 N GARDEN AVE
ROSWELL NM
88201-7534
US

IV. Provider business mailing address

PO BOX 99
ROSWELL NM
88202-0099
US

V. Phone/Fax

Practice location:
  • Phone: 575-208-0676
  • Fax: 575-625-1973
Mailing address:
  • Phone: 575-208-0676
  • Fax: 575-625-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number54998
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number55850
License Number StateNM

VIII. Authorized Official

Name: MR. CAMRON LEE ADAMS
Title or Position: PRESIDENT
Credential:
Phone: 575-208-2725