Provider Demographics
NPI:1740280403
Name:GREGORY SKIE MD PA
Entity type:Organization
Organization Name:GREGORY SKIE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SKIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-453-7771
Mailing Address - Street 1:700 HUNTERS ROW CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4001
Mailing Address - Country:US
Mailing Address - Phone:817-453-7771
Mailing Address - Fax:817-453-6149
Practice Address - Street 1:700 HUNTERS ROW CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4001
Practice Address - Country:US
Practice Address - Phone:817-453-7771
Practice Address - Fax:817-453-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5617208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1673295Medicaid
TX1673295Medicaid
C21876Medicare UPIN