1659352698 NPI number — SCHWARZ CARDIOLOGY PLLC PA

Table of content: (NPI 1659352698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659352698 NPI number — SCHWARZ CARDIOLOGY PLLC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHWARZ CARDIOLOGY PLLC PA
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:
SCHWARZ CARDIOLOGY
Provider Other Organization Name Type Code:
3
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:
1659352698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3387
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72913-3387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-709-7300
Provider Business Mailing Address Fax Number:
479-709-7308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6101 PHOENIX AVE
Provider Second Line Business Practice Location Address:
CON/ARC PLACE #3
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72903-5083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-709-7300
Provider Business Practice Location Address Fax Number:
479-709-7308
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARZ
Authorized Official First Name:
JULIO
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT / DOCTOR
Authorized Official Telephone Number:
479-709-7300

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  R3827 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010178600 . This is a "BLACK LUNG PROVIDER NUMBE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 51100 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 7300 . This is a "OKLA MEDICAID GROUP PIN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100728470A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146018002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04D0092195 . This is a "CLIA NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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