Healthcare Provider Details

I. General information

NPI: 1831703297
Provider Name (Legal Business Name): SKYLINE SURGICAL STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 COUNTY ROAD 4223
DECATUR TX
76234-8339
US

IV. Provider business mailing address

284 COUNTY ROAD 4223
DECATUR TX
76234-8339
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARCO PENA
Title or Position: OWNER
Credential: CSFA
Phone: 806-535-9197