1952306375 NPI number — DR. REBECCA JOAN SCHOETTLE M.D.

Table of content: DR. REBECCA JOAN SCHOETTLE M.D. (NPI 1952306375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952306375 NPI number — DR. REBECCA JOAN SCHOETTLE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHOETTLE
Provider First Name:
REBECCA
Provider Middle Name:
JOAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1952306375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1735 27TH STREET
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45662-2657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-353-6500
Provider Business Mailing Address Fax Number:
740-354-5389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1735 27TH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45662-2657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-353-6500
Provider Business Practice Location Address Fax Number:
740-354-5389
Provider Enumeration Date:
06/14/2005

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: 208000000X , with the licence number:  35-04-8393 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 65942898 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000359860 . This is a "ANTHEM BLUE CROSS/BLUE S" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000359860 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4316548 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0599213 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201893650 . This is a "HEALTH NET FEDERAL SERVIC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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