1689847451 NPI number — KATHY C SCHAEFER L.P.T.

Table of content: KATHY C SCHAEFER L.P.T. (NPI 1689847451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689847451 NPI number — KATHY C SCHAEFER L.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHAEFER
Provider First Name:
KATHY
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHAEFER
Provider Other First Name:
KATHY
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689847451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 326
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUNKER HILL
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62014-0326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-585-4761
Provider Business Mailing Address Fax Number:
618-585-3523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
128 NORTH WASHINGTON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUNKER HILL
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-585-4761
Provider Business Practice Location Address Fax Number:
618-585-3523
Provider Enumeration Date:
04/11/2008

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: 225100000X , with the licence number:  070003796 , 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)

  • Identifier: 910882 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5932026 . This is a "BLUE CROSS BLUE SHIELD OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 9465114 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2602740 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 708779 . This is a "ACN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com