MEDICARE: SKY HEALTH PLAN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1801275029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKY HEALTH PLAN, LLC

Provider Business Mailing Address
First Line	:	531 S MAIN ST
Second Line	:	SUITE 301
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2500
Country	:	US
Telephone Number	:	843-830-2783
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 S MAIN ST
Second Line	:	SUITE 301
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2500
Country	:	US
Telephone Number	:	843-830-2783
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MARCUS COMBS
Credential	:
Telephone Number	:	843-830-2783

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	05/20/2015

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