NPIMap

Organization Active NPI

Sky Lakes Medical Center Inc

  • General Practice Physician
  • Klamath Falls, OR
National Provider Identifier
1649446691
Registry record updated Dec 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
SKY LAKES MEDICAL CENTER INC
Practice address
2821 Daggett Ave Ste 100
Klamath Falls, OR 97601-1130
Phone
(541) 274-6733
NPI assigned
Apr 30, 2008
Last updated
Dec 15, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SKY LAKES MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 15, 2020

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

Authorized official

Name
Mr. Richard E Rico
Title
VP
Phone
(541) 274-6150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

2821 Daggett Ave Ste 100
Klamath Falls, OR 97601-1130

Mailing address

2865 Daggett Ave
Klamath Falls, OR 97601-1106
Phone (541) 274-6733

Other practice location 1

2801 Daggett Ave
Klamath Falls, OR 97601-1106
Phone (541) 274-6733

Other identifiers 3

IdentifierTypeStateIssuer
500740745MedicaidOR
066167MedicaidOR
002500XGGMedicaidOR

National Provider Directory

National Provider Directory
Tax ID family
Merle West Medical CNTR23 organizations share this tax ID, including this one
Part of
Merle West Medical CNTR

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

2821 Daggett Ave
Klamath Falls, OR 97601
Phone (541) 274-6733

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607990400000",
    "number": "1649446691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2865 DAGGETT AVE",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011106",
            "telephone_number": "541-274-6733",
            "fax_number": "541-274-6247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 DAGGETT AVE STE 100",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011130",
            "telephone_number": "541-274-6733"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2801 Daggett Ave",
            "address_purpose": "LOCATION",
            "city": "Klamath Falls",
            "state": "OR",
            "postal_code": "976011106",
            "country_code": "US",
            "telephone_number": "541-274-6733",
            "fax_number": "541-274-6247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SKY LAKES MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SKY LAKES MEDICAL CENTER INC",
        "enumeration_date": "2008-04-30",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "RICO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "541-274-6150",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500740745",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "066167",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002500XGG",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; 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.