1386843399 NPI number — WILLIAM R SCHMITT, MD, INC

Table of content: (NPI 1386843399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386843399 NPI number — WILLIAM R SCHMITT, MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM R SCHMITT, MD, INC
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:
1386843399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 N PALM CANYON DR
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92262-4414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-322-3166
Provider Business Mailing Address Fax Number:
760-322-9309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 N PALM CANYON DR
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-4414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-322-3166
Provider Business Practice Location Address Fax Number:
760-322-9309
Provider Enumeration Date:
07/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CANIFF
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALER, BILLER
Authorized Official Telephone Number:
760-322-3166

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  G37914 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VE0102X , with the licence number: G37914 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: ZZZ50078Y . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A978690 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G379140 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0105270 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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