1073796405 NPI number — SALLY A SCHUCK N.P.

Table of content: SALLY A SCHUCK N.P. (NPI 1073796405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073796405 NPI number — SALLY A SCHUCK N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUCK
Provider First Name:
SALLY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARKINSON
Provider Other First Name:
SALLY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073796405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47733-3407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-450-6815
Provider Business Mailing Address Fax Number:
812-450-6822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MARY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47747-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-450-3405
Provider Business Practice Location Address Fax Number:
812-450-3099
Provider Enumeration Date:
12/07/2007

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: 363L00000X , with the licence number:  71002562A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000546681 . This is a "ANTHEM PIN - MARY ST" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000547016 . This is a "ANTHEM - GATEWAY BLVD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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