1003835778 NPI number — TODD M SCHNEIDER OD

Table of content: TODD M SCHNEIDER OD (NPI 1003835778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003835778 NPI number — TODD M SCHNEIDER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNEIDER
Provider First Name:
TODD
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1003835778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 S UNIVERSITY AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BEAVER DAM
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53916-3053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-887-1151
Provider Business Mailing Address Fax Number:
920-887-3353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 S UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BEAVER DAM
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53916-3053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-887-1151
Provider Business Practice Location Address Fax Number:
920-887-3353
Provider Enumeration Date:
07/19/2006

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: 152W00000X , with the licence number:  1413 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1006595 . This is a "PHYSICIANS PLUS HMO" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 410032599 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 10365 . This is a "CEAN CARE HMO" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 38562000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: WI0117 . This is a "JOHN DEERE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39115615603 . This is a "UNITY HMO" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 391156156 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12233 . This is a "NETWORK HEALTH PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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