1619018256 NPI number — MR. EUGENE WILLIAM SCHUSTER CADC

Table of content: MR. EUGENE WILLIAM SCHUSTER CADC (NPI 1619018256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619018256 NPI number — MR. EUGENE WILLIAM SCHUSTER CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUSTER
Provider First Name:
EUGENE
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CADC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FULTON
Provider Other First Name:
MARY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CADC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619018256
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:
101 S LOCUST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTRALIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62801-3506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-533-1390
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 S LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62801-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-533-1390
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2007

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: 101YA0400X , with the licence number:  23222 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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