Provider Demographics
NPI:1710130158
Name:STAN V SKREPNEK MDPA
Entity Type:Organization
Organization Name:STAN V SKREPNEK MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:SKREPNEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-723-2547
Mailing Address - Street 1:126 MEDICAL DR
Mailing Address - Street 2:STE B
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8506
Mailing Address - Country:US
Mailing Address - Phone:903-723-2547
Mailing Address - Fax:
Practice Address - Street 1:126 MEDICAL DR
Practice Address - Street 2:STE B
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8506
Practice Address - Country:US
Practice Address - Phone:903-723-2547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0010Medicare PIN