MEDICARE: STEVEN LEO SKILES P.A.-C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	PA03657	TX
2	363A00000X	Physician Assistant	PA03657	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083621569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN LEO SKILES P.A.-C.

Provider Business Mailing Address
First Line	:	7257 HAWKINS VIEW DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3921
Country	:	US
Telephone Number	:	817-735-9397
Fax Number	:	817-735-8340

Provider Business Practice Location Address
First Line	:	7257 HAWKINS VIEW DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3921
Country	:	US
Telephone Number	:	817-735-9397
Fax Number	:	817-735-8340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	09/17/2012

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