Organization
SKY LAKES MEDICAL CENTER INC
Active
Parent organization
SKY LAKES MEDICAL CENTER INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SKY LAKES MEDICAL CENTER INC
Authorized official
MR. RICHARD E RICO (VP)
(541) 274-6150
Entity
Organization
Contact information
Practice address
2821 DAGGETT AVE STE 100, KLAMATH FALLS, OR 97601-1130
(541) 274-6733
Mailing address
2865 DAGGETT AVE, KLAMATH FALLS, OR 97601-1106
(541) 274-6733
(541) 274-6247
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002500XGG
—
OR
05
—
066167
—
OR
05
—
500740745
—
OR
Enumeration date
04/30/2008
Last updated
12/15/2020
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