1811080336 NPI number — SCHARRUHN & BARLEY PROFESSIONAL MEDICAL CORP

Table of content: MADISON KAY GUTKNECHT (NPI 1932854601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811080336 NPI number — SCHARRUHN & BARLEY PROFESSIONAL MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHARRUHN & BARLEY PROFESSIONAL MEDICAL CORP
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:
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:
1811080336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1004 FOWLER WAY
Provider Second Line Business Mailing Address:
SUITE #1
Provider Business Mailing Address City Name:
PLACERVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95667-5746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-626-8003
Provider Business Mailing Address Fax Number:
530-626-8082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 FOWLER WAY
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-5746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-626-8003
Provider Business Practice Location Address Fax Number:
530-626-8082
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHARRUHN
Authorized Official First Name:
KATHARINA
Authorized Official Middle Name:
RUTH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
530-626-8003

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ23232Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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