1609828326 NPI number — DR. CHARLES SCHAEFFER HERTZ JR. M.D.

Table of content: DR. CHARLES SCHAEFFER HERTZ JR. M.D. (NPI 1609828326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609828326 NPI number — DR. CHARLES SCHAEFFER HERTZ JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERTZ
Provider First Name:
CHARLES
Provider Middle Name:
SCHAEFFER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
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:
1609828326
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1691 GALISTEO ST
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-4780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-983-5631
Provider Business Mailing Address Fax Number:
505-982-5605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1691 GALISTEO ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-4780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-983-5631
Provider Business Practice Location Address Fax Number:
505-982-5605
Provider Enumeration Date:
05/17/2006

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: 207RG0100X , with the licence number:  13380 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: MD2011-0092 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4748210 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 53765 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 8160 . This is a "TLC PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100006289 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3187049 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4466329 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com