1447351994 NPI number — CRAIG S SCHEIN DPM

Table of content: CRAIG S SCHEIN DPM (NPI 1447351994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447351994 NPI number — CRAIG S SCHEIN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHEIN
Provider First Name:
CRAIG
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1447351994
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 SAINT JOHNS MEDICAL PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32086-5300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-824-0869
Provider Business Mailing Address Fax Number:
904-826-0966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SAINT JOHNS MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32086-5300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-824-0869
Provider Business Practice Location Address Fax Number:
904-826-0966
Provider Enumeration Date:
09/26/2006

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: 213E00000X , with the licence number:  0560000178 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: PO1827 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00058802 . This is a "BCBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 480035210 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 67484 . This is a "CIGNA NH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1009116 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03Y004127VT02 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5572620001 . This is a "MEDICARE DHE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 392204 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4859189 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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