1699928614 NPI number — MISS COURTNEY GAYLE SCHMIDT MOTR/L

Table of content: STEPHANIE NICOLE BRATTON DO (NPI 1861841132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699928614 NPI number — MISS COURTNEY GAYLE SCHMIDT MOTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMIDT
Provider First Name:
COURTNEY
Provider Middle Name:
GAYLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MOTR/L
Provider Gender Code:
F

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:
1699928614
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
965 RIDGE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-515-3192
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3570 WASHINGTON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15017-1089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-415-3192
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2008

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: 225X00000X , with the licence number:  OC010893 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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