Healthcare Provider Details

I. General information

NPI: 1316828841
Provider Name (Legal Business Name): SKILLED MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N SUNNY MDWS
MORGAN UT
84050-6823
US

IV. Provider business mailing address

316 N SUNNY MDWS
MORGAN UT
84050-6823
US

V. Phone/Fax

Practice location:
  • Phone: 801-821-7920
  • Fax: 866-492-0442
Mailing address:
  • Phone: 801-821-7920
  • Fax: 866-492-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MCKENNAN J THURSTON
Title or Position: MANAGER
Credential: MD
Phone: 801-821-7980