Provider Demographics
NPI:1013721463
Name:SKINNER MEDICAL LLC
Entity type:Organization
Organization Name:SKINNER MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:580-977-4721
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-0378
Mailing Address - Country:US
Mailing Address - Phone:580-977-4721
Mailing Address - Fax:605-273-3695
Practice Address - Street 1:607 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-6704
Practice Address - Country:US
Practice Address - Phone:580-977-4721
Practice Address - Fax:605-273-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty