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General NPI Number Information
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NPI Number | 1336154202
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Entity Type | Organization
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Legal Business Name | SKYLINE MEDICAL GROUP LLC
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 3443 DICKERSON PIKE SUITE G-30
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City | NASHVILLE
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State | TN
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Zip | 37207-2519
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Country | US
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Telephone | 615-234-6390
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Fax | 615-234-6393
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Provider Business Mailing Address
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Address Line | 3443 DICKERSON PIKE SUITE G-30
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City | NASHVILLE
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State | TN
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Zip | 37207-2519
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Country | US
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Telephone | 615-234-6390
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Fax | 615-234-6393
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JEFF RYDBURG
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Credential |
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Telephone | 615-373-7415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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