1336101633 NPI number — DR. TROY M SCHWARTZ D.O.

Table of content: DR. TROY M SCHWARTZ D.O. (NPI 1336101633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336101633 NPI number — DR. TROY M SCHWARTZ D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWARTZ
Provider First Name:
TROY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1336101633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 HOPE DR BLDG 6000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN HOME AFB
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83648-1062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-828-7297
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 HOPE DR BLDG 6000
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN HOME AFB
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-828-7297
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2006

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: 207Q00000X , with the licence number:  02002670A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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