1477699726 NPI number — MR. ALBERT LAWRENCE SCHOCH PAC

Table of content: MR. ALBERT LAWRENCE SCHOCH PAC (NPI 1477699726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477699726 NPI number — MR. ALBERT LAWRENCE SCHOCH PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHOCH
Provider First Name:
ALBERT
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PAC
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:
1477699726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8807 111TH ST CT SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-984-0928
Provider Business Mailing Address Fax Number:
253-966-7653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17TH & C STREET
Provider Second Line Business Practice Location Address:
BUILDING 11582 OKYBO HEALTH CLINIC
Provider Business Practice Location Address City Name:
FORT LEWIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-966-7545
Provider Business Practice Location Address Fax Number:
253-966-7653
Provider Enumeration Date:
01/30/2007

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: 363A00000X , with the licence number:  PACCERTIFICATION#100 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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