Provider Demographics
NPI:1447425731
Name:SKYLINE CARDIOVASCULAR INSTITUTE PLC
Entity Type:Organization
Organization Name:SKYLINE CARDIOVASCULAR INSTITUTE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:I
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:731-410-6777
Mailing Address - Street 1:PO BOX 1798
Mailing Address - Street 2:DEPT 07-075
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-1798
Mailing Address - Country:US
Mailing Address - Phone:731-410-6777
Mailing Address - Fax:731-410-6778
Practice Address - Street 1:111 STONEBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2040
Practice Address - Country:US
Practice Address - Phone:731-410-6777
Practice Address - Fax:731-410-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty