Provider Demographics
NPI:1609504208
Name:SKAGGS, JOSEPH CHASE I (CSFA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CHASE
Last Name:SKAGGS
Suffix:I
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 MCQUEARY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-8828
Mailing Address - Country:US
Mailing Address - Phone:270-566-4630
Mailing Address - Fax:
Practice Address - Street 1:256 MCQUEARY RIDGE RD
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-8828
Practice Address - Country:US
Practice Address - Phone:270-566-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant