1659340370 NPI number — SKY LAKES MEDICAL CENTER INC

Table of content: (NPI 1659340370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659340370 NPI number — SKY LAKES MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKY LAKES MEDICAL CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659340370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2865 DAGGETT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KLAMATH FALLS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97601-1106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-274-6221
Provider Business Mailing Address Fax Number:
541-274-6247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2865 DAGGETT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97601-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-274-6221
Provider Business Practice Location Address Fax Number:
541-274-6247
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICO
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
541-274-6150

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 140724 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01556 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017881103 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020406500A , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100457850A , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 066167 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZR20101F , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152371 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7126139 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717315600 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82508600 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP60101F , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011198 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0033522 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0413257 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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