| Skyline Medicine | |
|
6112 E Brown Rd Mesa AZ 85205-4955 | |
| (480) 924-4422 | |
| Not Available |
| Full Name | Skyline Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 6112 E Brown Rd, Mesa, Arizona |
| Authorized Official Name and Position | Kerry Green (OWNER) |
| Authorized Official Contact | 4809244422 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Skyline Medicine 6112 E Brown Rd Mesa AZ 85205-4955 Ph: (480) 924-4422 | Skyline Medicine 6112 E Brown Rd Mesa AZ 85205-4955 Ph: (480) 924-4422 |
| NPI Number | 1356523492 |
|---|---|
| Provider Enumeration Date | 11/30/2007 |
| Last Update Date | 03/08/2012 |
| Medicare PECOS PAC ID | 3476538729 |
|---|---|
| Medicare Enrollment ID | O20040621001436 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356523492 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 29662 (Arizona) | Primary |
| Provider Name | Kerry S Green |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801835350 PECOS PAC ID: 5890770150 Enrollment ID: I20060316000444 |
| Provider Name | Stephen L Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508849985 PECOS PAC ID: 4082756754 Enrollment ID: I20100118000266 |
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