1043560642 NPI number — CRESCENT PSYCHIATRY PLLC

Table of content: PETER THOMAS SCHEFFEL MD (NPI 1326157074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043560642 NPI number — CRESCENT PSYCHIATRY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRESCENT PSYCHIATRY PLLC
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:
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:
1043560642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2852 GIBRALTAR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75062-5298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1604 HOSPITAL PKWY STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76022-6930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-354-2888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FAHEEM
Authorized Official First Name:
SABAHAT
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
817-354-2888

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: TXB166118 . This is a "MEDICARE ID" identifier . This identifiers is of the category "OTHER".




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