Provider Demographics
NPI:1316828841
Name:SKILLED MD, LLC
Entity type:Organization
Organization Name:SKILLED MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MCKENNAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-614-5700
Mailing Address - Street 1:1090 W 4150 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2226
Mailing Address - Country:US
Mailing Address - Phone:801-614-5700
Mailing Address - Fax:866-492-0442
Practice Address - Street 1:1090 W 4150 N
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84414-2226
Practice Address - Country:US
Practice Address - Phone:801-614-5700
Practice Address - Fax:866-492-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty