1811075732 NPI number — MED GROUP DBA

Table of content: DR. JOSHUA SCHNELL PT, DPT (NPI 1285135087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811075732 NPI number — MED GROUP DBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED GROUP DBA
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:
Provider Other Organization Name Type Code:
6
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:
1811075732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
147 N. COLLEGIATE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75460-4842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-784-6300
Provider Business Mailing Address Fax Number:
903-784-6310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
147 N. COLLEGIATE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75460-4842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-784-6300
Provider Business Practice Location Address Fax Number:
903-784-6310
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PICKERING
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
DOYLE
Authorized Official Title or Position:
ADMINISTRATOR/OWNER
Authorized Official Telephone Number:
903-784-6300

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 010927 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 205268001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010927 . This is a "HOME AND COMMUNITY SUPPOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".