Healthcare Provider Details

I. General information

NPI: 1942156328
Provider Name (Legal Business Name): SKY LAKES MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 KLAMATH AVE
KLAMATH FALLS OR
97601-6199
US

IV. Provider business mailing address

710 KLAMATH AVE
KLAMATH FALLS OR
97601-6199
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-6406
  • Fax:
Mailing address:
  • Phone: 541-274-6406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ANDREW M MOLATORE
Title or Position: CFO
Credential:
Phone: 541-274-6150