MEDICARE: MRS. BETH M SKILLINS PA-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	363AM0700X	Medical Physician Assistant	PA03790	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	828013194	OTHER	TX	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1447207246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH M SKILLINS PA-C

Provider Business Mailing Address
First Line	:	8945 LONG POINT RD
Second Line	:	212
City	:	HOUSTON
State	:	TX
Zip	:	77055-3034
Country	:	US
Telephone Number	:	713-464-7212
Fax Number	:

Provider Business Practice Location Address
First Line	:	8945 LONG POINT RD
Second Line	:	212
City	:	HOUSTON
State	:	TX
Zip	:	77055-3034
Country	:	US
Telephone Number	:	713-464-7212
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/23/2010

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