Provider Demographics
NPI:1477526341
Name:SKYLINE MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:SKYLINE MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:FITZGIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-289-4031
Mailing Address - Street 1:1908 N 203RD ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2889
Mailing Address - Country:US
Mailing Address - Phone:402-289-4031
Mailing Address - Fax:402-289-3185
Practice Address - Street 1:1908 N 203RD ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-2889
Practice Address - Country:US
Practice Address - Phone:402-289-4031
Practice Address - Fax:402-289-3185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477526341OtherNPI
28D0713450OtherCLIA
NE=========-13Medicaid
NE=========OtherTAX ID NUMBER