1023296159 NPI number — DEBRA BECK SCHROECK MS, PA-C

Table of content: DEBRA BECK SCHROECK MS, PA-C (NPI 1023296159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023296159 NPI number — DEBRA BECK SCHROECK MS, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHROECK
Provider First Name:
DEBRA
Provider Middle Name:
BECK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BECK
Provider Other First Name:
DEBRA
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023296159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 STETSON ST
Provider Second Line Business Mailing Address:
SUITE 3200 ML 0516
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45219-2492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-558-0956
Provider Business Mailing Address Fax Number:
513-558-3399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 STETSON ST
Provider Second Line Business Practice Location Address:
SUITE 3200 ML 0516
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219-2492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-558-0956
Provider Business Practice Location Address Fax Number:
513-558-3399
Provider Enumeration Date:
01/31/2008

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: 363A00000X , with the licence number:  PA1099 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 50. 002262 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00866124 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00799583 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100088670 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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