1245292812 NPI number — LOUISE E SCHOTTSTAEDT MD

Table of content: LOUISE E SCHOTTSTAEDT MD (NPI 1245292812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245292812 NPI number — LOUISE E SCHOTTSTAEDT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHOTTSTAEDT
Provider First Name:
LOUISE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARCIA
Provider Other First Name:
LOUISE
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245292812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1925 E ORMAN SUITE 440
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-560-4744
Provider Business Mailing Address Fax Number:
719-560-4770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 E ORMAN SUITE 440
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-560-4744
Provider Business Practice Location Address Fax Number:
719-560-4770
Provider Enumeration Date:
04/06/2006

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: 207Q00000X , with the licence number:  27483 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01274836 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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