Provider Demographics
NPI:1942557434
Name:BLUE SKIES HEALTH CARE, INC
Entity type:Organization
Organization Name:BLUE SKIES HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:OSWALD
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:575-544-7387
Mailing Address - Street 1:400 HORSESHOE DR APT A
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-5246
Mailing Address - Country:US
Mailing Address - Phone:575-544-7387
Mailing Address - Fax:
Practice Address - Street 1:400 HORSESHOE DR APT A
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5246
Practice Address - Country:US
Practice Address - Phone:575-544-7387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health