Healthcare Provider Details

I. General information

NPI: 1235657321
Provider Name (Legal Business Name): PA SKILLS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 N MAIN ST
CEDAR CITY UT
84721-9746
US

IV. Provider business mailing address

1335 S 860 W
CEDAR CITY UT
84720-3708
US

V. Phone/Fax

Practice location:
  • Phone: 520-858-5758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PATRICK THOMPSON
Title or Position: OWNER
Credential: PA-C
Phone: 520-858-5758