Provider Demographics
NPI:1811745979
Name:SKIDMORE, ROBERT SR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SKIDMORE
Suffix:SR
Gender:M
Credentials:
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 131
Mailing Address - Street 2:
Mailing Address - City:HAYWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26366-0131
Mailing Address - Country:US
Mailing Address - Phone:304-670-9984
Mailing Address - Fax:
Practice Address - Street 1:89 WILKINSON ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-5953
Practice Address - Country:US
Practice Address - Phone:304-629-2037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide