1093706616 NPI number — MARY K SCHAEFER PA-C

Table of content: MRS. CAREN B SURLOW R.D. (NPI 1366686776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093706616 NPI number — MARY K SCHAEFER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHAEFER
Provider First Name:
MARY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1093706616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 W GLYNN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKSTON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57366-9605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-928-7961
Provider Business Mailing Address Fax Number:
605-928-7368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 W GLYNN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKSTON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57366-9605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-928-7961
Provider Business Practice Location Address Fax Number:
605-928-7368
Provider Enumeration Date:
11/02/2005

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:  0388 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0007354 . This is a "WELLMARK PARKSTON" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4997644 . This is a "WELLMARK - LAKE ANDES" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4997652 . This is a "WELLMARK - TRIPP" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5340340 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9247664 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5340070 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6821750 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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