1962606897 NPI number — MARY SCHWARTZ, DPM. PC.

Table of content: (NPI 1962606897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962606897 NPI number — MARY SCHWARTZ, DPM. PC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY SCHWARTZ, DPM. PC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1962606897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46563-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-316-0306
Provider Business Mailing Address Fax Number:
574-239-0478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46563-1744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-316-0306
Provider Business Practice Location Address Fax Number:
574-239-0478
Provider Enumeration Date:
06/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
574-935-4068

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  07000938 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 07000938 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0007273484 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200353690 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000521416 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00403293 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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