Provider Demographics
NPI:1144070673
Name:BLUE SKIES ANESTHESIA LLC
Entity type:Organization
Organization Name:BLUE SKIES ANESTHESIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:R
Authorized Official - Last Name:TESCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-876-0033
Mailing Address - Street 1:PO BOX 150721
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0721
Mailing Address - Country:US
Mailing Address - Phone:801-876-0033
Mailing Address - Fax:
Practice Address - Street 1:624 S 1000 E STE 105
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5902
Practice Address - Country:US
Practice Address - Phone:801-876-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty