Provider Demographics
NPI:1003130899
Name:PATRICK S. SKULEMOWSKI, DO , PA
Entity Type:Organization
Organization Name:PATRICK S. SKULEMOWSKI, DO , PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SKULEMOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PA
Authorized Official - Phone:956-554-9722
Mailing Address - Street 1:PO BOX 5395
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-5395
Mailing Address - Country:US
Mailing Address - Phone:956-554-9722
Mailing Address - Fax:956-554-9939
Practice Address - Street 1:3150 INTERNATIONAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3214
Practice Address - Country:US
Practice Address - Phone:956-554-9722
Practice Address - Fax:956-554-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220676501Medicaid
TX1003130899OtherMCR GRP NPI
TXTXB102421Medicare PIN