MEDICARE: SKYLINE MEDICAL, LLC

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
1	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician

General Provider Information

NPI Number	:	1598653222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYLINE MEDICAL, LLC

Provider Business Mailing Address
First Line	:	2610 S JONES BLVD STE D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5663
Country	:	US
Telephone Number	:	702-591-3055
Fax Number	:

Provider Business Practice Location Address
First Line	:	2610 S JONES BLVD STE D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5663
Country	:	US
Telephone Number	:	702-591-3055
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALIST
Name	:	TAMI V BASS
Credential	:
Telephone Number	:	702-591-3055

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	06/24/2025

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