1831163674 NPI number — CORA YVONNE SCHAFER PA

Table of content: CORA YVONNE SCHAFER PA (NPI 1831163674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831163674 NPI number — CORA YVONNE SCHAFER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHAFER
Provider First Name:
CORA
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HADDOX
Provider Other First Name:
CORA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831163674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
CORSICANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75110-2415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-872-3005
Provider Business Mailing Address Fax Number:
903-872-3050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
CORSICANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75110-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-872-3005
Provider Business Practice Location Address Fax Number:
903-875-7229
Provider Enumeration Date:
02/16/2006

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: 363A00000X , with the licence number:  PA00095 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 189751401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DG9311 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00Y226 . This is a "MEDICARE GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00463089 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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