1366653081 NPI number — STEPHEN F. SCHOLLE MD PA

Table of content: (NPI 1366653081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366653081 NPI number — STEPHEN F. SCHOLLE MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN F. SCHOLLE MD PA
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:
BEACH FAMILY MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
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:
1366653081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6970
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33932-6970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-765-0007
Provider Business Mailing Address Fax Number:
239-765-0247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1661 ESTERO BLVD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33931-2846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-765-0007
Provider Business Practice Location Address Fax Number:
239-765-0247
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHOLLE
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-765-0007

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  ME0033695 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 90071995 . This is a "MEDICARE RAIL ROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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