1497713689 NPI number — JERRY A SCHEXNAYDER MD

Table of content: JERRY A SCHEXNAYDER MD (NPI 1497713689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497713689 NPI number — JERRY A SCHEXNAYDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHEXNAYDER
Provider First Name:
JERRY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1497713689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2829 E HIGHWAY 76
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MULLINS
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29574-6035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-431-2280
Provider Business Mailing Address Fax Number:
843-431-2297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2829 E HIGHWAY 76
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MULLINS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29574-6035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-431-2280
Provider Business Practice Location Address Fax Number:
843-431-2297
Provider Enumeration Date:
05/04/2006

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: 207X00000X , with the licence number:  18802 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1129707004 . This is a "CIGNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 632831 . This is a "AETNA HMO NETWORK" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 01839531 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1061050 . This is a "WV WORKERS COMPENSATION" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 188022 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890511L , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0599453 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 720507 . This is a "MB EVOLUTIONS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 232753 . This is a "CHOICECARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 263155 . This is a "ONE HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 873957 . This is a "FIRST HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP5462 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 720506 . This is a "MI EVOLUTIONS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: A154 . This is a "NC UHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5417700 . This is a "HEALTHSOURCE/CIGNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 5828006 . This is a "AETNA OPEN NETWORK" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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