Provider Demographics
NPI:1508962200
Name:MISTY SKORCZ MD PA
Entity Type:Organization
Organization Name:MISTY SKORCZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKORCZ MD PA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-518-0009
Mailing Address - Street 1:2050 W BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-1927
Mailing Address - Country:US
Mailing Address - Phone:727-518-0009
Mailing Address - Fax:727-587-0251
Practice Address - Street 1:2050 W BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-1927
Practice Address - Country:US
Practice Address - Phone:727-518-0009
Practice Address - Fax:727-587-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88283282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH99080Medicare UPIN
FLU1160AMedicare ID - Type Unspecified