Organization Name: | SKY LAKES MEDICAL CENTER INC |
NPI Number: | 1255628673 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD E RICO (VP) |
Mailing Address: | 3000 Bryant Williams Dr Klamath Falls |
State: | OR US |
Postal Code: | 976011139 |
Phone Number: | 5412746221 |
Fax Number: | 5412746247 |
NPI Enumeration Date: | 07/06/2011 |
NPI Last Update Date: | 09/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 14-0724-3 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |