1659684405 NPI number — SCHRECKENGHAUST MICHEL & PACK INC

Table of content: (NPI 1659684405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659684405 NPI number — SCHRECKENGHAUST MICHEL & PACK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHRECKENGHAUST MICHEL & PACK INC
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:
THE RIDE
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:
1659684405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 38
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOKOMIS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34274-0038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-485-1911
Provider Business Mailing Address Fax Number:
941-485-1935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 TAMIAMI TRL S
Provider Second Line Business Practice Location Address:
SUITE 272
Provider Business Practice Location Address City Name:
VENICE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34285-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-485-1911
Provider Business Practice Location Address Fax Number:
941-485-1935
Provider Enumeration Date:
07/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SCHRECKENGHAUST
Authorized Official First Name:
REX
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
941-485-1911

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001218100 . This is a "AGENCY FOR PERSONS WITH DISABILITIES - STATE OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com