1427127703 NPI number — MR. TERRY L. SCHROCK MS, LMHC

Table of content: STEPHANIE RICHTER (NPI 1083083778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427127703 NPI number — MR. TERRY L. SCHROCK MS, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHROCK
Provider First Name:
TERRY
Provider Middle Name:
L.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, LMHC
Provider Gender Code:
M

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:
1427127703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2321 BROOKWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOGANSPORT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46947-1205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-456-5900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1907 W SYCAMORE ST
Provider Second Line Business Practice Location Address:
ST. JOSEPH HOSPITAL & HEALTH CENTER
Provider Business Practice Location Address City Name:
KOKOMO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46904-9010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-456-5900
Provider Business Practice Location Address Fax Number:
765-456-5815
Provider Enumeration Date:
11/08/2006

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: 101YM0800X , 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: 000000391215 . This is a "ANTHEM BXBS ID NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 11548735 . This is a "CAQH ID NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: SCHRO-0006 . This is a "COMPCARE ID NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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