1194105502 NPI number — MILES D. SCHROEDER AND GERALYN M. SCHROEDER, P.C.

Table of content: (NPI 1194105502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194105502 NPI number — MILES D. SCHROEDER AND GERALYN M. SCHROEDER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILES D. SCHROEDER AND GERALYN M. SCHROEDER, P.C.
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:
1194105502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8028 E 10TH ST
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46219-5242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-897-8028
Provider Business Mailing Address Fax Number:
317-897-8025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8028 E 10TH ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46219-5242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-897-8028
Provider Business Practice Location Address Fax Number:
317-897-8025
Provider Enumeration Date:
06/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SCHROEDER
Authorized Official First Name:
MILES
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
317-897-8028

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7381 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 7658 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1447397765 . This is a "NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200190760A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com