1124146634 NPI number — LORETTA K. SCHMIDGALL, O.D., PC

Table of content: (NPI 1124146634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124146634 NPI number — LORETTA K. SCHMIDGALL, O.D., PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LORETTA K. SCHMIDGALL, O.D., PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1124146634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3211 CARLISLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17315-4515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-292-3668
Provider Business Mailing Address Fax Number:
717-292-1034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3211 CARLISLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17315-4515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-292-3668
Provider Business Practice Location Address Fax Number:
717-292-1034
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMIDGALL
Authorized Official First Name:
LORETTA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-292-3668

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000268 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00148941 . This is a "MEDICARE RR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SC113345 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95045 . This is a "VISION BENEFITS OF AMER" identifier . This identifiers is of the category "OTHER".
  • Identifier: A13345 . This is a "AMERIHEALTH ADMIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0104701000 . This is a "AMERIHEALTH 65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01528701 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01898579 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2421907 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00148941 . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01528701 . This is a "NCAS PENNSYLVANIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02523900 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18107 . This is a "HEALTH AMER HEALTH ASSUR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01528701 . This is a "KEYSTONE HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5748087 . This is a "FIRST HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00148941 . This is a "MEDICARE ID" identifier . This identifiers is of the category "OTHER".




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