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General NPI Number Information
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NPI Number | 1649499690
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Entity Type | Organization
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Legal Business Name | SKY PROSTHETICS INC
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 503 CHIEF ST
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City | BENKELMAN
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State | NE
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Zip | 69021-3065
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Country | US
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Telephone | 308-423-2690
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Fax | 308-423-2691
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Provider Business Mailing Address
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Address Line | 503 CHIEF ST
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City | BENKELMAN
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State | NE
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Zip | 69021-3065
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Country | US
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Telephone | 308-423-2690
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Fax | 308-423-2691
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | BENJAMIN WAYNE BLECHA
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Credential | C.P.O.
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Telephone | 308-423-2690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CPO 2571
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License Number State | VA
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