=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598574659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKYCARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2025
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1705 OHIO DR STE 200
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-5257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-288-9288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1705 OHIO DR STE 200
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-5257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-288-9288
-----------------------------------------------------
Fax | 886-531-7854
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SKY LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-440-2667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------