1124162367 NPI number — DR. WILLIAM J SCHENCK DC

Table of content: DR. WILLIAM J SCHENCK DC (NPI 1124162367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124162367 NPI number — DR. WILLIAM J SCHENCK DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHENCK
Provider First Name:
WILLIAM
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1124162367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 979
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLISTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05495-0979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-878-8330
Provider Business Mailing Address Fax Number:
802-878-8344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 CORNERSTONE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLISTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05495-4035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-878-8330
Provider Business Practice Location Address Fax Number:
802-878-8344
Provider Enumeration Date:
02/19/2007

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: 111NN0400X , with the licence number:  006-0000870 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NN1001X , with the licence number: 006-0000870 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NR0400X , with the licence number: 006-0000870 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SCH00018942 . This is a "BCBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 03036 . This is a "CBA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 80705 . This is a "GREAT WEST" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: T87083 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com