Organization
SKY LAKES MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD E RICO CPA (VP)
(541) 274-6150
Entity
Organization
Contact information
Practice address
2230 N ELDORADO AVE, KLAMATH FALLS, OR 97601-6418
(541) 274-8989
(541) 274-4334
Mailing address
2865 DAGGETT AVE, KLAMATH FALLS, OR 97601-1106
(541) 274-6221
(541) 274-6247
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138005000
BCBS REGENCE
OR
05
—
207639
—
OR
Enumeration date
05/22/2006
Last updated
05/22/2009
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