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NPI Code Detail

MEDICARE: SKY LAKES MEDICAL CENTER INC

MEDICARE: SKY LAKES MEDICAL CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1138005000OTHERORBCBS REGENCE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386698207
Entity Type Code : Organization
Provider Name (Legal Business Name) : SKY LAKES MEDICAL CENTER INC
Provider Business Mailing Address
First Line : 2865 DAGGETT AVE
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-1106
Country : US
Telephone Number : 541-274-6221
Fax Number : 541-274-6247
Provider Business Practice Location Address
First Line : 2230 N ELDORADO AVE
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-6418
Country : US
Telephone Number : 541-274-8989
Fax Number : 541-274-4334
Authorized Official
Title or Position : VP
Name : MR. RICHARD E RICO
Credential : CPA
Telephone Number : 541-274-6150
Provider Enumeration Date : 05/22/2006
Last Update Date : 05/22/2009

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Directions to “SKY LAKES MEDICAL CENTER INC ” Practice Location

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