1295712164 NPI number — SHIRL L SCHAFFER MD

Table of content: SHIRL L SCHAFFER MD (NPI 1295712164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295712164 NPI number — SHIRL L SCHAFFER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHAFFER
Provider First Name:
SHIRL
Provider Middle Name:
L
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:
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:
1295712164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 840857
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-0857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9127 W RUSSELL RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-1253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-878-0070
Provider Business Practice Location Address Fax Number:
303-780-0787
Provider Enumeration Date:
12/30/2005

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: 207L00000X , with the licence number:  39821 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 114691 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 21813 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04204549 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100457880A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84113438513 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3506685 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40755738 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116784700 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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