Healthcare Provider Details

I. General information

NPI: 1104900513
Provider Name (Legal Business Name): SKYLINE FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 N SHENANDOAH AVE
FRONT ROYAL VA
22630-3501
US

IV. Provider business mailing address

841 N SHENANDOAH AVE
FRONT ROYAL VA
22630-3501
US

V. Phone/Fax

Practice location:
  • Phone: 540-636-7000
  • Fax: 540-636-7029
Mailing address:
  • Phone: 540-636-7000
  • Fax: 540-636-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PATSY ANN CLARK
Title or Position: FRONT OFFICE MANAGER
Credential:
Phone: 540-636-7000