| Skye Consultorio Medico Llc | |
|
3813 Ross Clark Cir Ste 300 Dothan AL 36303-2881 | |
| (334) 479-0505 | |
| Not Available |
| Full Name | Skye Consultorio Medico Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3813 Ross Clark Cir Ste 300, Dothan, Alabama |
| Authorized Official Name and Position | Robert Tate (CEO) |
| Authorized Official Contact | 3342338283 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Skye Consultorio Medico Llc 1107 N Eastern Blvd Montgomery AL 36117-2290 Ph: (334) 647-1444 | Skye Consultorio Medico Llc 3813 Ross Clark Cir Ste 300 Dothan AL 36303-2881 Ph: (334) 479-0505 |
| NPI Number | 1821835893 |
|---|---|
| Provider Enumeration Date | 07/09/2024 |
| Last Update Date | 07/09/2024 |
| Medicare PECOS PAC ID | 2860933918 |
|---|---|
| Medicare Enrollment ID | O20240917002796 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821835893 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Elva Calderon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679012629 PECOS PAC ID: 5496022998 Enrollment ID: I20170605002985 |
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