1891401212 NPI number — ELDERIZE VON SCHILLING WORTH BA, CT, CTR

Table of content: ELDERIZE VON SCHILLING WORTH BA, CT, CTR (NPI 1891401212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891401212 NPI number — ELDERIZE VON SCHILLING WORTH BA, CT, CTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VON SCHILLING WORTH
Provider First Name:
ELDERIZE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA, CT, CTR
Provider Gender Code:
F

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:
1891401212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2310 S GREEN BAY RD STE C226
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RACINE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53406-4957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-285-1331
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2310 S GREEN BAY RD STE C266
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RACINE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53406-4957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-285-1331
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2023

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: 225400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 92-1960720 . This is a "WORKERS COMPENSATION AND PERSONAL INJURY" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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