Provider Demographics
NPI:1487734679
Name:SKYLINE MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:SKYLINE MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:413-731-9988
Mailing Address - Street 1:PO BOX 80384
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01138-0384
Mailing Address - Country:US
Mailing Address - Phone:413-731-9988
Mailing Address - Fax:413-731-5381
Practice Address - Street 1:754 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2218
Practice Address - Country:US
Practice Address - Phone:413-731-9988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1537806Medicaid
379654OtherBCBS MA
379654OtherBCBS MA