Provider Demographics
NPI:1275836264
Name:W. RONALD SKOWSKY, MD. LLC.
Entity Type:Organization
Organization Name:W. RONALD SKOWSKY, MD. LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-841-2820
Mailing Address - Street 1:1801 FAIRFIELD AVE
Mailing Address - Street 2:STE 307
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4443
Mailing Address - Country:US
Mailing Address - Phone:318-841-2820
Mailing Address - Fax:318-841-2821
Practice Address - Street 1:1801 FAIRFIELD AVE
Practice Address - Street 2:STE 307
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4443
Practice Address - Country:US
Practice Address - Phone:318-841-2820
Practice Address - Fax:318-841-2821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:W. RONALD SKOWSKY, MD. LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12346R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1430625Medicaid
LA1430625Medicaid
LA5H267Medicare PIN