Healthcare Provider Details

I. General information

NPI: 1356817886
Provider Name (Legal Business Name): BICYCLE HEALTH PROVIDER GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 GATEWAY PLACE 5TH FLOOR, OFFICE 647
SAN JOSE CA
95110
US

IV. Provider business mailing address

PO BOX 32750
BELFAST ME
04915-0220
US

V. Phone/Fax

Practice location:
  • Phone: 844-943-2514
  • Fax:
Mailing address:
  • Phone: 844-943-2514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS EUGENE SCHAMBER
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 765-661-2491