1275536120 NPI number — DR. JAMES E SCHABERG M.D.

Table of content: DR. JAMES E SCHABERG M.D. (NPI 1275536120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275536120 NPI number — DR. JAMES E SCHABERG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHABERG
Provider First Name:
JAMES
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1275536120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12639 OLD TESSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63128-2786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-849-0311
Provider Business Mailing Address Fax Number:
314-849-4423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9323 PHOENIX VILLAGE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63366-4281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-561-5030
Provider Business Practice Location Address Fax Number:
636-561-5033
Provider Enumeration Date:
05/24/2005

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: 207X00000X , with the licence number:  R5A61 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3458V6032 . This is a "GHP/ADVANTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4442V6097 . This is a "HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: SP10134 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 119366 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45616 . This is a "CMR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9044 . This is a "EXCLUSIVE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18655 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4061265 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 900097 . This is a "UHC" identifier . This identifiers is of the category "OTHER".




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