Healthcare Provider Details

I. General information

NPI: 1104829126
Provider Name (Legal Business Name): CHRISTOPHER J SKOCIK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 CENTRAL CTR
CHILLICOTHEE OH
45601-2248
US

IV. Provider business mailing address

272 HOSPITAL RD
CHILLICOTHEE OH
45601-9031
US

V. Phone/Fax

Practice location:
  • Phone: 740-774-2800
  • Fax: 740-774-2803
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34004836S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: