1285806919 NPI number — PREMIER SURGICAL ASSOCIATES, PLLC

Table of content: MADISON LORENE SCHROEDER LPC (NPI 1649979162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285806919 NPI number — PREMIER SURGICAL ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER SURGICAL ASSOCIATES, 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:
6
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:
1285806919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52948
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37950-2948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-474-7096
Provider Business Mailing Address Fax Number:
888-606-4409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6408 PAPERMILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919-4858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-474-7096
Provider Business Practice Location Address Fax Number:
888-606-4409
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROM
Authorized Official First Name:
JEROME
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
513-561-8900

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1455291 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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