1417925991 NPI number — DR. RUDOLPH SCHILLI M.D.

Table of content: DR. RUDOLPH SCHILLI M.D. (NPI 1417925991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417925991 NPI number — DR. RUDOLPH SCHILLI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHILLI
Provider First Name:
RUDOLPH
Provider Middle Name:
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:
1417925991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 SOMERSET AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDBER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15963-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-535-2511
Provider Business Mailing Address Fax Number:
814-535-8473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 SOMERSET AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDBER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15963-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-2511
Provider Business Practice Location Address Fax Number:
814-535-8473
Provider Enumeration Date:
03/09/2006

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: 207RG0100X , with the licence number:  MD022109E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0643815 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251323499 . This is a "CHAMPUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 65408 . This is a "MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 089582 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1503542 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 089582E8P . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 143582501 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0649600 . This is a "UNITED MINE WORKERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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