Provider Demographics
NPI:1376045617
Name:BLUE SKY ORTHOTIC AND PROSTHETICS
Entity Type:Organization
Organization Name:BLUE SKY ORTHOTIC AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-231-1313
Mailing Address - Street 1:1104 W 34TH ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1908
Mailing Address - Country:US
Mailing Address - Phone:970-231-1313
Mailing Address - Fax:512-505-8886
Practice Address - Street 1:3411 MARKET LOOP STE 112
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2771
Practice Address - Country:US
Practice Address - Phone:970-231-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE SKY ORTHOTIC AND PROSTHETICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101597335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier