Provider Demographics
NPI:1124852066
Name:BLUE SKY PRIMARY CARE PA
Entity type:Organization
Organization Name:BLUE SKY PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-680-7207
Mailing Address - Street 1:111 S WHITTIER RD STE 330
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1045
Mailing Address - Country:US
Mailing Address - Phone:316-689-4203
Mailing Address - Fax:
Practice Address - Street 1:111 S WHITTIER RD STE 330
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1045
Practice Address - Country:US
Practice Address - Phone:316-689-4203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty