1962444810 NPI number — DR. JAY REGGIE SCHACHNER MD

Table of content: DR. MARIO ALBERTO VELASQUEZ DNP, ARNP, PMHNP-BC (NPI 1467107474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962444810 NPI number — DR. JAY REGGIE SCHACHNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHACHNER
Provider First Name:
JAY
Provider Middle Name:
REGGIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1962444810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75391-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-997-8000
Provider Business Mailing Address Fax Number:
972-437-9605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
690 N 14TH ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77702-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-899-7180
Provider Business Practice Location Address Fax Number:
409-899-7186
Provider Enumeration Date:
06/12/2006

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: 207RX0202X , with the licence number:  G9530 , 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: 137522201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137522205 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137522203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137522207 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8R1544 . This is a "BLUE CROSS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 137522202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137522206 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137522211 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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