Provider Demographics
NPI:1003135831
Name:BLUE SKY HEALTH
Entity Type:Organization
Organization Name:BLUE SKY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHAHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-709-7556
Mailing Address - Street 1:P.O. BOX 687
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75123
Mailing Address - Country:US
Mailing Address - Phone:972-709-7556
Mailing Address - Fax:972-709-7611
Practice Address - Street 1:407 N CEDAR RIDGE DR
Practice Address - Street 2:#320
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3197
Practice Address - Country:US
Practice Address - Phone:972-709-7556
Practice Address - Fax:972-709-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM97912084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB107233Medicare Oscar/Certification