Healthcare Provider Details

I. General information

NPI: 1053246041
Provider Name (Legal Business Name): SKY LAKES MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 DAGGETT AVE STE 201
KLAMATH FALLS OR
97601-1129
US

IV. Provider business mailing address

2821 DAGGETT AVE STE 201
KLAMATH FALLS OR
97601-1129
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-3150
  • Fax:
Mailing address:
  • Phone: 541-274-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

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