NPIMap

Organization Active NPI

Skyline Wound Care Midwest LLC

  • Plastic and Reconstructive Surgery Physician
  • St. Petersburg, FL
National Provider Identifier
1295445179
Registry record updated Mar 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
SKYLINE WOUND CARE MIDWEST LLC
Practice address
7901 4TH St N
Ste 300
St. Petersburg, FL 33702
Phone
(877) 970-4200
Fax
(786) 677-4292
NPI assigned
Dec 1, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sharon Palacios
Title
Credentialing Coordinator
Phone
(877) 940-7200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0122X Primary

Addresses

Primary practice location

7901 4TH St N
Ste 300
St. Petersburg, FL 33702

Mailing address

7742 N Kendall Dr # 446
Miami, FL 33156-7523
Phone (877) 970-4200

Other practice location 1

6900 N Stalworth Dr
Peoria, IL 61615-9444
Phone (309) 693-1400

National Provider Directory

National Provider Directory

Locations

620 W Bridgeport St
White Hall, IL 62092
Phone (217) 374-2144

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680220800000",
    "number": "1295445179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7742 N KENDALL DR # 446",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331567523",
            "telephone_number": "877-970-4200",
            "fax_number": "786-677-4292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7901 4TH ST N",
            "address_2": "STE 300",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "33702",
            "telephone_number": "877-970-4200",
            "fax_number": "786-677-4292"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6900 N Stalworth Dr",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616159444",
            "country_code": "US",
            "telephone_number": "309-693-1400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SKYLINE WOUND CARE MIDWEST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-01",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A",
        "authorized_official_last_name": "PALACIOS",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "877-940-7200"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St. Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.