Provider Demographics
NPI:1295445179
Name:SKYLINE WOUND CARE MIDWEST LLC
Entity type:Organization
Organization Name:SKYLINE WOUND CARE MIDWEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-940-7200
Mailing Address - Street 1:7742 N KENDALL DR # 446
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7523
Mailing Address - Country:US
Mailing Address - Phone:877-970-4200
Mailing Address - Fax:786-677-4292
Practice Address - Street 1:7901 4TH ST N
Practice Address - Street 2:STE 300
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702
Practice Address - Country:US
Practice Address - Phone:877-970-4200
Practice Address - Fax:786-677-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty