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General NPI Number Information
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NPI Number | 1942557434
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Entity Type | Organization
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Legal Business Name | BLUE SKIES HEALTH CARE, INC
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 400 HORSESHOE DR APT A
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City | DEMING
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State | NM
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Zip | 88030-5246
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Country | US
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Telephone | 575-544-7387
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Fax |
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Provider Business Mailing Address
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Address Line | 400 HORSESHOE DR APT A
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City | DEMING
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State | NM
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Zip | 88030-5246
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Country | US
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Telephone | 575-544-7387
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. OWEN OSWALD O'CONNOR SR.
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Credential |
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Telephone | 575-544-7387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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