Provider Demographics
NPI:1407635642
Name:SKYBLUE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:SKYBLUE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-333-8228
Mailing Address - Street 1:2400 OLD MILTON PKWY UNIT 722
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1727
Mailing Address - Country:US
Mailing Address - Phone:833-333-8228
Mailing Address - Fax:833-333-8228
Practice Address - Street 1:2400 OLD MILTON PKWY UNIT 722
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30009-1727
Practice Address - Country:US
Practice Address - Phone:833-333-8228
Practice Address - Fax:833-333-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)