1770591760 NPI number — CHRISTOPHER STEPHEN SCHAFER PA-C

Table of content: CHRISTOPHER STEPHEN SCHAFER PA-C (NPI 1770591760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770591760 NPI number — CHRISTOPHER STEPHEN SCHAFER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHAFER
Provider First Name:
CHRISTOPHER
Provider Middle Name:
STEPHEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1770591760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 751649
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28275-1649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-789-1620
Provider Business Mailing Address Fax Number:
843-724-2440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2145 HENRY TECKLENBURG DR STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29414-5894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-723-8823
Provider Business Practice Location Address Fax Number:
843-766-6551
Provider Enumeration Date:
08/04/2006

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: 363A00000X , with the licence number:  897 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 897 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 897 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1225006760 . This is a "GROUP NPI #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 20000499 . This is a "GROUP SELECT HEALTH PROVIDER #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 56162 . This is a "MEDCOST PAYOR ID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 57-0634057 . This is a "GROUP TAX ID #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: PA0971 . This is a "GROUP MEDICAID #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 042299001 . This is a "GROUP DMERC #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: CD28777 . This is a "GROUP MEDICARE RAILROAD #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1326287434 . This is a "GROUP MEDICARE DME NPI #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1701 . This is a "GROUP MEDICARE PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 20076508 . This is a "GROUP SELECT HEALTH DME #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 461555 . This is a "GROUP MEDICARE DME #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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