1063522498 NPI number — KEARLEY & SCHMITT PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063522498 NPI number — KEARLEY & SCHMITT PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEARLEY & SCHMITT PLLC
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:
1063522498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1433 FAIRFIELD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78758-7244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-491-8444
Provider Business Mailing Address Fax Number:
512-491-0226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1433 FAIRFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78758-7244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-491-8444
Provider Business Practice Location Address Fax Number:
512-491-0226
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEARLEY
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
O
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
512-491-8444

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  00175U , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 155006301 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 00175U , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 454908 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 155006302 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 155006301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155006302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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