1285773655 NPI number — CRAIG I. SCHWARTZ, D.O., P.A.

Table of content: (NPI 1285773655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285773655 NPI number — CRAIG I. SCHWARTZ, D.O., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAIG I. SCHWARTZ, D.O., P.A.
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:
1285773655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 E 104TH ST STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64131-4561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-451-8346
Provider Business Mailing Address Fax Number:
913-451-8347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 E 104TH ST STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64131-4561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-451-8346
Provider Business Practice Location Address Fax Number:
913-451-8347
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
I
Authorized Official Title or Position:
OWNER-PRESIDENT
Authorized Official Telephone Number:
913-451-8346

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  05-30131 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DB6536 . This is a "RR MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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