MEDICARE: BLUE SKY DESIGNS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		MN
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1144508250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE SKY DESIGNS, INC.

Provider Business Mailing Address
First Line	:	2637 27TH AVE S
Second Line	:	SUITE 209
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1565
Country	:	US
Telephone Number	:	612-724-7002
Fax Number	:	888-311-4435

Provider Business Practice Location Address
First Line	:	2637 27TH AVE S
Second Line	:	SUITE 209
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1565
Country	:	US
Telephone Number	:	612-724-7002
Fax Number	:	888-311-4435

Authorized Official
Title or Position	:	PRESIDENT/REHABILITATION ENGINEER
Name	:	MS. DIANNE GOODWIN
Credential	:	ATP
Telephone Number	:	612-724-7002

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	07/25/2011

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