MEDICARE: EDWARD WILLIAM SCHEINERT IDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1578861324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD WILLIAM SCHEINERT IDC

Provider Business Mailing Address
First Line	:	2424 RENDOVA RD SUITE 156
Second Line	:	NSWG-1 LOGSUPPU
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5401
Country	:	US
Telephone Number	:	619-437-5612
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 RENDOVA RD SUITE 156
Second Line	:	NSWG-1 LOGSUPPU
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5401
Country	:	US
Telephone Number	:	619-437-5612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	03/03/2011

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