Basic Information
| Provider Information | |||||||||
| NPI: | 1669428033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SKYLINE EMERGENCY PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 592 | ||||||||
| Address2: | 501 SUNSET LANE, | ||||||||
| City: | CULPEPER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 227010500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408298838 | ||||||||
| FaxNumber: | 5408295757 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 SUNSET LN | ||||||||
| Address2: | |||||||||
| City: | CULPEPER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 227010500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408298838 | ||||||||
| FaxNumber: | 5408295757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 06/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | ROSEN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5408294100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | N/A | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 231217 | 01 | VA | BLUE SHIELD | OTHER |