1124040266 NPI number — MARK D SKYIEPAL MD

Table of content: MARK D SKYIEPAL MD (NPI 1124040266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124040266 NPI number — MARK D SKYIEPAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKYIEPAL
Provider First Name:
MARK
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124040266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
791 N HIGHWAY 77
Provider Second Line Business Mailing Address:
STE 501-C #239
Provider Business Mailing Address City Name:
WAXAHACHIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75165-1977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-558-5756
Provider Business Mailing Address Fax Number:
888-558-5754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 S 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98274-4117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-814-2600
Provider Business Practice Location Address Fax Number:
360-814-8390
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  J1570 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: MD61639297 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: J1570 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 2334 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 046230104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 046230105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 046230106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100217995 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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