MEDICARE: BRYSON MILES SKELTON CSFA

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	246ZC0007X	Surgical Assistant	198542	SC

General Provider Information

NPI Number	:	1417812736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYSON MILES SKELTON CSFA

Provider Business Mailing Address
First Line	:	515 S FISH TRAP RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-7042
Country	:	US
Telephone Number	:	828-696-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 S FISH TRAP RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-7042
Country	:	US
Telephone Number	:	828-696-1000
Fax Number	:

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

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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