Provider Demographics
NPI:1093832057
Name:SKY VALLEY FAMILY MEDICINE, PS
Entity Type:Organization
Organization Name:SKY VALLEY FAMILY MEDICINE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:RANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-793-0201
Mailing Address - Street 1:615 W STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:SULTAN
Mailing Address - State:WA
Mailing Address - Zip Code:98294-9458
Mailing Address - Country:US
Mailing Address - Phone:360-793-0201
Mailing Address - Fax:360-793-2429
Practice Address - Street 1:615 W STEVENS AVE
Practice Address - Street 2:
Practice Address - City:SULTAN
Practice Address - State:WA
Practice Address - Zip Code:98294-9458
Practice Address - Country:US
Practice Address - Phone:360-793-0201
Practice Address - Fax:360-793-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7116882Medicaid
WA8807389Medicare ID - Type UnspecifiedMEDICARE GROUP #