Basic Information
| Provider Information | |||||||||
| NPI: | 1285097683 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SKYLINE MEDICAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6005 WALHAVEN DR | ||||||||
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| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223102621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038882850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5276 DAWES AVE | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223111404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5717778494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2016 | ||||||||
| LastUpdateDate: | 11/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | TETEMKE | ||||||||
| AuthorizedOfficialFirstName: | TESFAYE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5717778494 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101244617 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.