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General NPI Number Information
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NPI Number | 1316828841
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Entity Type | Organization
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Legal Business Name | SKILLED MD, LLC
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 12/13/2025
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Provider Practice Location Address
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Address Line | 316 N SUNNY MDWS
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City | MORGAN
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State | UT
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Zip | 84050-6823
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Country | US
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Telephone | 801-821-7920
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Fax | 866-492-0442
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Provider Business Mailing Address
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Address Line | 316 N SUNNY MDWS
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City | MORGAN
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State | UT
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Zip | 84050-6823
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Country | US
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Telephone | 801-821-7920
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Fax | 866-492-0442
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Authorized Official
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Title or Position | MANAGER
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Name | MCKENNAN J THURSTON
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Credential | MD
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Telephone | 801-821-7980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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