Healthcare Provider Details

I. General information

NPI: 1629310404
Provider Name (Legal Business Name): SKY LAKES MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 MAIN ST
KLAMATH FALLS OR
97601-2638
US

IV. Provider business mailing address

2865 DAGGETT AVE
KLAMATH FALLS OR
97601-1106
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-6221
  • Fax:
Mailing address:
  • Phone: 541-274-6221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number14-0724
License Number StateOR

VIII. Authorized Official

Name: RICHARD RICO
Title or Position: VP/CFO
Credential:
Phone: 541-274-6150