Provider Demographics
NPI:1134157118
Name:SKYLINE PRIMARY CARE, LLC
Entity type:Organization
Organization Name:SKYLINE PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-865-9057
Mailing Address - Street 1:510 HOSPITAL DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5033
Mailing Address - Country:US
Mailing Address - Phone:615-865-9057
Mailing Address - Fax:
Practice Address - Street 1:510 HOSPITAL DR
Practice Address - Street 2:SUITE 410
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5033
Practice Address - Country:US
Practice Address - Phone:615-865-9057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty