1154659449 NPI number — RONALD MERLE SCHUNK III CRT,RRT

Table of content: RONALD MERLE SCHUNK III CRT,RRT (NPI 1154659449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154659449 NPI number — RONALD MERLE SCHUNK III CRT,RRT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUNK
Provider First Name:
RONALD
Provider Middle Name:
MERLE
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
CRT,RRT
Provider Gender Code:
M

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:
1154659449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8276 N ROCKY BROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85743-1478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-579-7960
Provider Business Mailing Address Fax Number:
520-844-8221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 W SAINT MARYS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85745-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-872-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/24/2009

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: 227900000X , with the licence number:  5133 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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