1952331605 NPI number — KIMBERLY K. SCHULZ

Table of content: (NPI 1952331605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952331605 NPI number — KIMBERLY K. SCHULZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIMBERLY K. SCHULZ
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:
TOWN SQUARE DERMATOLOGY, PLC
Provider Other Organization Name Type Code:
3
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:
1952331605
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 6TH ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
CORALVILLE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52241-1755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-337-4566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CORALVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52241-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-337-4566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTIANSON
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
319-337-4566

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  32786 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207N00000X , with the licence number: 31541 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 001292 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0466557 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14-77506814 . This is a "NPI -WALLING" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: I20222 . This is a "PTAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 2208108 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0497545 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12-25017718 . This is a "NPI -SCHULZ" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 17-30128653 . This is a "NPI - ROBSON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 18-11967219 . This is a "NPI - MCKEE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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