Provider Demographics
NPI:1558433250
Name:RONALD N SKUFCA DO PA
Entity Type:Organization
Organization Name:RONALD N SKUFCA DO PA
Other - Org Name:HEALTHCARE CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:NORTON
Authorized Official - Last Name:SKUFCA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-826-2151
Mailing Address - Street 1:5315 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-7418
Mailing Address - Country:US
Mailing Address - Phone:214-826-2151
Mailing Address - Fax:214-826-2639
Practice Address - Street 1:5315 ROSS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7418
Practice Address - Country:US
Practice Address - Phone:214-826-2151
Practice Address - Fax:214-826-2639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RONALD N SKUFCA, DO PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158302301Medicaid
TX158302302Medicaid
TX158302302Medicaid