=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770905481
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATE SKAGGS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2014
-----------------------------------------------------
Last Update Date | 08/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 BENCHMARK RD STE 203
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-470-4914
-----------------------------------------------------
Fax | 970-470-4015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4539
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81620-4539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-470-4914
-----------------------------------------------------
Fax | 970-470-4915
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD-OWNER
-----------------------------------------------------
Name | KATHERINE SKAGGS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 970-376-0264
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 40655
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------