Provider Demographics
NPI:1669428033
Name:SKYLINE EMERGENCY PHYSICIANS, LLC
Entity type:Organization
Organization Name:SKYLINE EMERGENCY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-829-4100
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:501 SUNSET LANE,
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-0500
Mailing Address - Country:US
Mailing Address - Phone:540-829-8838
Mailing Address - Fax:540-829-5757
Practice Address - Street 1:501 SUNSET LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-0500
Practice Address - Country:US
Practice Address - Phone:540-829-8838
Practice Address - Fax:540-829-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA231217OtherBLUE SHIELD
VA231217OtherBLUE SHIELD
VAC05217Medicare PIN
VA231217OtherBLUE SHIELD