1275706491 NPI number — MARK J SCHULD MD PC

Table of content: (NPI 1275706491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275706491 NPI number — MARK J SCHULD MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK J SCHULD MD PC
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:
6
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:
1275706491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 STATE ROAD 46
Provider Second Line Business Mailing Address:
PO BOX 537
Provider Business Mailing Address City Name:
RILEY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-894-2304
Provider Business Mailing Address Fax Number:
812-894-3604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 STATE ROAD 46
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RILEY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-894-2304
Provider Business Practice Location Address Fax Number:
812-894-3604
Provider Enumeration Date:
04/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULD
Authorized Official First Name:
MARK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-894-2304

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01045428A , 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: DC1530 . This is a "PALMETTO GBA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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