1285643189 NPI number — CHARLES E SCHOLTES

Table of content: CHARLES E SCHOLTES (NPI 1285643189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285643189 NPI number — CHARLES E SCHOLTES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHOLTES
Provider First Name:
CHARLES
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1285643189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506-7250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-328-8833
Provider Business Mailing Address Fax Number:
402-328-2921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8207 NORTHWOODS DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68505-2093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-466-0555
Provider Business Practice Location Address Fax Number:
402-488-0743
Provider Enumeration Date:
08/07/2006

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: 363AS0400X , with the licence number:  251 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 39059 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".