NPIMap

Organization Active NPI

Sky Lakes Medical Center Inc

Doing business as Sky Lakes Downtown Pharmacy

  • Community/Retail Pharmacy
  • Klamath Falls, OR
National Provider Identifier
1841704459
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
RP-0003343-CS Issued in OR
Legal business name
SKY LAKES MEDICAL CENTER INC
Doing business as
Sky Lakes Downtown Pharmacy
Practice address
211 N 8TH St
Klamath Falls, OR 97601-6018
Phone
(541) 274-3480
Fax
(541) 274-3485
NPI assigned
Nov 20, 2017
Last updated
Jul 19, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

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

Authorized official

Name
Richard Rico
Title
Cfo
Phone
(541) 274-6150

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X RP-0003343-CS OR Primary

Addresses

Primary practice location

211 N 8TH St
Klamath Falls, OR 97601-6018

Mailing address

211 N 8TH St.
Klamath Falls, OR 97601
Phone (541) 274-3480

Other identifiers 1

IdentifierTypeStateIssuer
2176548OtherPK

Other names 1

  • Sky Lakes Downtown Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180814002122 OR Part B Supplier - Mass Immunization (Roster Biller Only) 1052204096 Practice locations: Klamath Falls, OR

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Cascade ENT Facial PL23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1511136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1841704459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 N 8TH ST.",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "97601",
            "telephone_number": "541-274-3480",
            "fax_number": "541-274-3485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 N 8TH ST",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976016018",
            "telephone_number": "541-274-3480",
            "fax_number": "541-274-3485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKY LAKES MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-20",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "RICO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "541-274-6150"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP-0003343-CS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2176548",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sky Lakes Downtown Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.