1255332813 NPI number — DR. REID M SCHROEDER MD

Table of content: DR. REID M SCHROEDER MD (NPI 1255332813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255332813 NPI number — DR. REID M SCHROEDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHROEDER
Provider First Name:
REID
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1255332813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 VALLEY VIEW DR
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-6150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-762-1072
Provider Business Mailing Address Fax Number:
309-762-1094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 VALLEY VIEW DR
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-6150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-762-1072
Provider Business Practice Location Address Fax Number:
309-762-1094
Provider Enumeration Date:
08/04/2005

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: 2085R0202X , with the licence number:  31995 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 63896-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 036-086734 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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