Basic Information
Provider Information | |||||||||
NPI: | 1134437551 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SKEBA | ||||||||
FirstName: | SARAH | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KING | ||||||||
OtherFirstName: | SARAH | ||||||||
OtherMiddleName: | M | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PA-C | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2566 HAYMAKER RD STE 311 | ||||||||
Address2: |   | ||||||||
City: | MONROEVILLE | ||||||||
State: | PA | ||||||||
PostalCode: | 151463555 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4123596800 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2566 HAYMAKER RD STE 311 | ||||||||
Address2: |   | ||||||||
City: | MONROEVILLE | ||||||||
State: | PA | ||||||||
PostalCode: | 151463555 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4123596800 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/20/2010 | ||||||||
LastUpdateDate: | 07/11/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/11/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | MA056052 | PA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
ID | Type | State | Issuer | Description | 12573993 | 01 |   | CAQH | OTHER | 103229310 | 05 | PA |   | MEDICAID |