Provider Demographics
NPI:1922052349
Name:SKEEN, THOMAS V (CRNA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:V
Last Name:SKEEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-0608
Mailing Address - Country:US
Mailing Address - Phone:765-932-7520
Mailing Address - Fax:765-932-7505
Practice Address - Street 1:1300 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1116
Practice Address - Country:US
Practice Address - Phone:765-932-7520
Practice Address - Fax:765-932-7505
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28055891A207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200063800AMedicaid
IN000000818891OtherANTHEM BCBS