Provider Demographics
NPI:1902943012
Name:SKYLAND MRI LLC
Entity Type:Organization
Organization Name:SKYLAND MRI LLC
Other - Org Name:SKYLAND MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-684-2420
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-0580
Mailing Address - Country:US
Mailing Address - Phone:828-684-2420
Mailing Address - Fax:828-687-0729
Practice Address - Street 1:1998 HENDERSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-687-8141
Practice Address - Fax:828-687-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015P4Medicaid
NC015P4OtherBCBS
NCP00215051OtherRR MEDICARE
NC2881780Medicare ID - Type Unspecified