Provider Demographics
NPI:1528666195
Name:SKYLAND PROSTHETICS & ORTHOTICS INC
Entity type:Organization
Organization Name:SKYLAND PROSTHETICS & ORTHOTICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRONK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-684-1644
Mailing Address - Street 1:3845 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-8241
Mailing Address - Country:US
Mailing Address - Phone:828-436-5347
Mailing Address - Fax:
Practice Address - Street 1:1141 TUNNEL RD STE F
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2037
Practice Address - Country:US
Practice Address - Phone:828-436-5347
Practice Address - Fax:828-255-6999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKYLAND PROSTHETICS & ORTHOTICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-15
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700057Medicaid
NC0496AOtherBCBS