Provider Demographics
NPI:1124071071
Name:SKYLINE PRIMARY CARE LLC
Entity type:Organization
Organization Name:SKYLINE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7604
Mailing Address - Street 1:510 HOSPITAL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5033
Mailing Address - Country:US
Mailing Address - Phone:615-865-9232
Mailing Address - Fax:615-865-4159
Practice Address - Street 1:510 HOSPITAL DR
Practice Address - Street 2:SUITE 150
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5033
Practice Address - Country:US
Practice Address - Phone:615-865-9232
Practice Address - Fax:615-865-4159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HTI HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734032Medicaid
TN3734032Medicaid
TN3734032Medicare PIN