=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396313482
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKY MEDICAL SUPPLIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2021
-----------------------------------------------------
Last Update Date | 06/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8340 E NORTHFIELD BLVD UNIT 1680
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80238-3184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-350-4073
-----------------------------------------------------
Fax | 720-612-4350
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20491 RANDOLPH PL
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80249-8593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-350-4073
-----------------------------------------------------
Fax | 720-612-4350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | HUSSIEN M HASSEN
-----------------------------------------------------
Credential | RN, RHIA
-----------------------------------------------------
Telephone | 303-709-3735
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------