1215969936 NPI number — ERIK L SCHROEDER MD

Table of content: ERIK L SCHROEDER MD (NPI 1215969936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215969936 NPI number — ERIK L SCHROEDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHROEDER
Provider First Name:
ERIK
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1215969936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 SUNNYVIEW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-3164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-752-7900
Provider Business Mailing Address Fax Number:
406-257-0253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 SUNNYVIEW LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59901-3164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-752-7900
Provider Business Practice Location Address Fax Number:
406-257-0253
Provider Enumeration Date:
07/06/2006

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: 207QS0010X , with the licence number:  11100 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11100 . This is a "STATE LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 1215969936 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215969936 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 1194070001 . This is a "CIGNA DME" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: P00451091 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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