1679578165 NPI number — JILL A SCHNEIDER OD

Table of content: JILL A SCHNEIDER OD (NPI 1679578165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679578165 NPI number — JILL A SCHNEIDER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNEIDER
Provider First Name:
JILL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1679578165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSBLUFF
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69363-0008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-632-2020
Provider Business Mailing Address Fax Number:
308-635-3641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 E 20TH PL
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SCOTTSBLUFF
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69361-2708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-632-2020
Provider Business Practice Location Address Fax Number:
308-635-3641
Provider Enumeration Date:
06/20/2005

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: 152W00000X , with the licence number:  1084 / 253 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 410048689 . This is a "PALMETTO GBA RAILROAD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 239736 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 06705 . This is a "BLUE CROSS/ BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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