Provider Demographics
NPI:1831949510
Name:SKY MOUNTAIN HEALTH LLC
Entity type:Organization
Organization Name:SKY MOUNTAIN HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:928-432-2853
Mailing Address - Street 1:7 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85543-9692
Mailing Address - Country:US
Mailing Address - Phone:928-432-2853
Mailing Address - Fax:
Practice Address - Street 1:7 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PIMA
Practice Address - State:AZ
Practice Address - Zip Code:85543-9692
Practice Address - Country:US
Practice Address - Phone:928-432-2853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty