Provider Demographics
NPI:1104900513
Name:SKYLINE FAMILY PRACTICE PC
Entity type:Organization
Organization Name:SKYLINE FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-636-7000
Mailing Address - Street 1:841 N SHENANDOAH AVE
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-3501
Mailing Address - Country:US
Mailing Address - Phone:540-636-7000
Mailing Address - Fax:540-636-7029
Practice Address - Street 1:841 N SHENANDOAH AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3501
Practice Address - Country:US
Practice Address - Phone:540-636-7000
Practice Address - Fax:540-636-7029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty