Provider Demographics
NPI:1649499690
Name:SKY PROSTHETICS INC
Entity type:Organization
Organization Name:SKY PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BLECHA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:308-423-2690
Mailing Address - Street 1:503 CHIEF ST
Mailing Address - Street 2:
Mailing Address - City:BENKELMAN
Mailing Address - State:NE
Mailing Address - Zip Code:69021-3065
Mailing Address - Country:US
Mailing Address - Phone:308-423-2690
Mailing Address - Fax:308-423-2691
Practice Address - Street 1:503 CHIEF ST
Practice Address - Street 2:
Practice Address - City:BENKELMAN
Practice Address - State:NE
Practice Address - Zip Code:69021-3065
Practice Address - Country:US
Practice Address - Phone:308-423-2690
Practice Address - Fax:308-423-2691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACPO 2571335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100025425600Medicaid
CO1659570Medicaid
KS0000118447OtherBLUE CROSS BLUE SHIELD
NE09904OtherBLUE CROSS BLUE SHIELD
NE09904OtherBLUE CROSS BLUE SHIELD