SKYLINE SURGERY CENTER LLC NPI 1851552483

NPI Information

SKYLINE SURGERY CENTER, LLC is an ambulatory surgical clinic center in Pocatello, ID. SKYLINE SURGERY CENTER, LLC NPI is 1851552483. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Skyline Surgery Center Inc.

The provider's business location address is:

285 VISTA DR
STE C
POCATELLO, ID
ZIP 83201
Phone: (208) 478-1704
Fax: (208) 233-6970

The provider's authorized official is Kathryn Buckalew .
The authorized official title is Administrator and has the following contact phone number (208) 785-3877.

The CLIA number assigned to this NPI record is 13D2053554 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/17/2008 and was last updated on 5/31/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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