1710062021 NPI number — STEVEN W SCHUMACHER CH

Table of content: STEVEN W SCHUMACHER CH (NPI 1710062021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710062021 NPI number — STEVEN W SCHUMACHER CH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUMACHER
Provider First Name:
STEVEN
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CH
Provider Gender Code:
M

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:
1710062021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24266-0037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-889-1314
Provider Business Mailing Address Fax Number:
276-889-4125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 HILL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-968-3311
Provider Business Practice Location Address Fax Number:
423-968-1512
Provider Enumeration Date:
10/26/2006

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: 111N00000X , with the licence number:  TN0000785 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3017158 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0000785 . This is a "TN LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: V01362 . This is a "CARE CHOICE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN11590 . This is a "CHPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3017158 . This is a "BLUE CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0104001371 . This is a "VA LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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