SKY LAKES PHYSICIAN SERVICES (NPI# 1831516772) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831516772 |
| Entity Type | Organization |
| Organization Name | SKY LAKES PHYSICIAN SERVICES |
| Practice Address |
2865 Daggett Ave Klamath Falls OR 97601-1106 |
| Practice Telephone | 5412746221 |
| Practice Fax Number | 5412746247 |
| Mailing Telephone | 5412746221 |
| Mailing Fax Number | 5412746247 |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2015-04-25 |
| Authorized Official Name | RICHARD RICO (VP/CFO) |
| Authorized Official Telephone | 5412746150 |
| Is Organization Subpart | Y |
| Parent Organization Name | SKY LAKES MEDICAL CENTER, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 146N00000X | Emergency Medical Technician, Basic | Emergency Medical Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SKY LAKES PHYSICIAN SERVICES | 2865 Daggett Ave, Klamath Falls, OR 97601 |
| Street Address |
2865 DAGGETT AVE |
| City | KLAMATH FALLS |
| State | OR |
| Zip Code | 97601-1106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982698221 | Slavka Kucinska | Internal Medicine | 2865 Daggett Ave, Klamath Falls, OR 97601 | 2005-09-01 |
| 1053928580 | Andie Leeann Scherer | Dietitian, Registered | 2865 Daggett Ave, Klamath Falls, OR 97601-1106 | 2020-09-29 |
| 1285241844 | Paolina Mulleneix | Dietitian, Registered | 2865 Daggett Ave, Klamath Falls, OR 97601-1106 | 2020-09-28 |
| 1073138814 | Merri Barber | Registered Nurse | 2865 Daggett Ave, Klamath Falls, OR 97601-1106 | 2020-06-08 |
| 1962038620 | Michelle Eileen Staunton | Pharmacist | 2865 Daggett Ave, Klamath Falls, OR 97601-1106 | 2020-03-13 |
| 1093355166 | Rachael Mudd | Physician Assistant | 2865 Daggett Ave, Klamath Falls, OR 97601-1106 | 2020-01-07 |
| 1235771874 | Derek Anthony Harpole | Nurse Practitioner | 2865 Daggett Ave, Klamath Falls, OR 97601-1106 | 2019-10-15 |
| 1538712286 | Alexander Edward Beaty | Pharmacist | 2865 Daggett Ave, Klamath Falls, OR 97601-1106 | 2019-07-22 |
| 1255992137 | David Rosser | Pharmacist | 2865 Daggett Ave, Klamath Falls, OR 97601-1106 | 2019-06-22 |
| 1518439470 | Justin Lee Thomas | Physical Therapist | 2865 Daggett Ave, Klamath Falls, OR 97601-1106 | 2018-12-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205487311 | Socorro Guadalupe Alcala- Peres | Case Manager/Care Coordinator | 2210 N El Dorado Ave, Klamath Falls, OR 97601 | 2019-09-20 |
| 1033760053 | Melissa Ann Roy | Counselor | 2210 North El Dorado, 2210 North El Dorado, Klamath Falls, OR 97601 | 2019-09-20 |
| 1134699721 | Kristin Asta Ragnarsson | Speech-Language Pathologist | Plum Ridge Care 1401 Bryant Williams, Klamath Falls, OR 97601 | 2018-11-27 |
| 1730667445 | Nancy Leota Baley | Pharmacist | Sky Lakes Outpatient Pharmacy, 2865 Daggett Street, Klamath Falls, OR 97601 | 2018-08-03 |
| 1336511260 | Patricia Blauvelt | Occupational Therapy Assistant | 1401 Bryant Williams Dr, Klamath Falls, OR 97601 | 2015-10-30 |
| 1598160814 | Christopher S. Turner | Counselor | 635 Main St., Klamath Falls, OR 97601 | 2014-10-29 |
| 1134472582 | Whole Person Care Family Practice | Family Medicine | 2301 Mountainview Blvd. Ste B, Klamath Falls, OR 97601 | 2012-10-23 |
| 1255692687 | Billy Dean Vermaas | Physical Medicine & Rehabilitation | 204 N. 10th Street, Klamath Falls, OR 97601 | 2012-06-01 |
| 1407140700 | Wendell C Heidinger Md | Family Medicine | 2301 Clairmont Drive, Klamath Falls, OR 97601 | 2011-06-03 |
| 1740573146 | Klamath Youh Department Center | Community/Behavioral Health | 2210 Eldordo Ave, Klamath Falls, OR 97601 | 2011-05-18 |
| Find all providers in zip 97601 | ||||
| Taxonomy Code | 146N00000X |
| Grouping | Emergency Medical Service Providers |
| Classification | Emergency Medical Technician, Basic |
| A Basic EMT is an individual trained and certified to perform basic life support treatment in medical emergencies based on individual state boards. |
| Notes: Sources: Tabers Medical Dictionary and Florida EMS Clearing House. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508474644 | Peter Lee | Emergency Medical Technician, Basic | 021 Sw Bancroft St, Portland, OR 97239-4064 | 2020-07-15 |
| 1447804570 | Elissa Burns | Emergency Medical Technician, Basic | 5806 Se Cesar E Chavez Blvd, Portland, OR 97202-7508 | 2019-07-26 |
| 1891136735 | Aram Novosel | Emergency Medical Technician, Basic | 51 Ne Grand Ave, Portland, OR 97232-2968 | 2013-07-08 |
| 1174892210 | Central Cascades Fire & Ems | Emergency Medical Technician, Basic | 20400 Crescent Lake Hwy, Crescent Lake, OR 97733-7044 | 2011-12-19 |
| 1073803433 | Daniel A Marro | Emergency Medical Technician, Basic | 755 W Quinalt St, Springfield, OR 97477-2756 | 2011-04-19 |
| 1831373539 | Debra Rae Oden | Emergency Medical Technician, Basic | 8538 Sw Appleway, Portland, OR 97225 | 2007-12-18 |
| 1629693429 | Adrienne Barnes | Emergency Medical Technician, Basic | 961 Nw Hayes Ave Apt 24, Corvallis, OR 97330-4581 | 2020-06-08 |
| 1417456104 | Marc Ian Kraidman | Emergency Medical Technician, Basic | 900 Se Baker St, Mcminnville, OR 97128-6808 | 2018-02-08 |
| 1154832319 | Wendy Oshinski | Emergency Medical Technician, Basic | 2727 Leo Harris Pkwy, Eugene, OR 97401-8835 | 2017-10-16 |
| 1902281868 | Garrett Skelton | Emergency Medical Technician, Basic | 2200 Ne Neff Rd, #200, Bend, OR 97701-4283 | 2015-07-21 |
| Find all providers with the same taxonomy | ||||
| City | KLAMATH FALLS |
| Zip Code | 97601 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.