Provider Demographics
NPI:1740822170
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:CEO
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 1:4704 MONTE CARMELO PL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6029
Mailing Address - Country:US
Mailing Address - Phone:970-231-1313
Mailing Address - Fax:
Practice Address - Street 1:3141 EAGLES NEST ST UNIT 220
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2334
Practice Address - Country:US
Practice Address - Phone:512-761-3646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier