| Organization Name: | SKY LAKES MEDICAL CENTER INC |
| NPI Number: | 1386931723 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD E RICO (VP) |
| Mailing Address: | 2200 Bryant Williams Dr Klamath Falls |
| State: | OR US |
| Postal Code: | 976011120 |
| Phone Number: | 5418826311 |
| Fax Number: | 5412746247 |
| NPI Enumeration Date: | 07/06/2011 |
| NPI Last Update Date: | 09/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 14-0724 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |