Provider Demographics
NPI:1215339601
Name:SKILLED MEDPROS
Entity type:Organization
Organization Name:SKILLED MEDPROS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-591-2495
Mailing Address - Street 1:222 FALLEN TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-5808
Mailing Address - Country:US
Mailing Address - Phone:814-591-2495
Mailing Address - Fax:866-832-1744
Practice Address - Street 1:222 FALLEN TIMBER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-5808
Practice Address - Country:US
Practice Address - Phone:814-591-2495
Practice Address - Fax:866-832-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD074428-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty