1891789285 NPI number — MS. LELA A SCHROTT PT

Table of content: MS. LELA A SCHROTT PT (NPI 1891789285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891789285 NPI number — MS. LELA A SCHROTT PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHROTT
Provider First Name:
LELA
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1891789285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1999 N AMIDON
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-262-8800
Provider Business Mailing Address Fax Number:
620-708-4022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1999 N AMIDON
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-262-8800
Provider Business Practice Location Address Fax Number:
620-708-4022
Provider Enumeration Date:
08/31/2005

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: 225100000X , with the licence number:  1102124 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 140908 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200317380A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8891 . This is a "PERFERRED PLUS OF KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 203178 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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