Provider Demographics
NPI:1952317760
Name:SKILES, BRUCE MARTIN (CRNA DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MARTIN
Last Name:SKILES
Suffix:
Gender:M
Credentials:CRNA DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 S FREEBORN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:KS
Mailing Address - Zip Code:66861-1256
Mailing Address - Country:US
Mailing Address - Phone:620-382-3711
Mailing Address - Fax:620-382-9104
Practice Address - Street 1:537 S FREEBORN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KS
Practice Address - Zip Code:66861-1256
Practice Address - Country:US
Practice Address - Phone:620-382-3711
Practice Address - Fax:620-382-9104
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4092111N00000X
KS1339715052RN367500000X
KS54167CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS145047OtherBCBS
KS100248650EMedicaid
KS100248650EMedicaid
KS145047OtherBCBS
KS023826Medicare ID - Type Unspecified
KSP00310015Medicare PIN