1164555660 NPI number — SCHUMAN-LILES CLINIC, INC

Table of content: (NPI 1164555660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164555660 NPI number — SCHUMAN-LILES CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHUMAN-LILES CLINIC, INC
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:
1164555660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10850 MACARTHUR BLVD
Provider Second Line Business Mailing Address:
300
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94605-5266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-569-9334
Provider Business Mailing Address Fax Number:
510-569-9309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39155 LIBERTY ST
Provider Second Line Business Practice Location Address:
G700
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94538-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-505-9141
Provider Business Practice Location Address Fax Number:
510-505-9145
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JENNINGS
Authorized Official First Name:
LJ
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
510-569-9334

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com