1538112966 NPI number — ERIC SUREN SCHULZE MD PHD

Table of content: ERIC SUREN SCHULZE MD PHD (NPI 1538112966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538112966 NPI number — ERIC SUREN SCHULZE MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHULZE
Provider First Name:
ERIC
Provider Middle Name:
SUREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
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:
1538112966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1888
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-945-2455
Provider Business Mailing Address Fax Number:
903-453-2541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7710T CHERRY PARK DR # 522
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77095-2725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-572-8456
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2006

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: 2085R0202X , with the licence number:  L1455 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: E4290 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD.12548R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 142957304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 142957307 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200101050A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161955001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78680352 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1535869 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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