Healthcare Provider Details

I. General information

NPI: 1184539140
Provider Name (Legal Business Name): BRENT SCHNEPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 GASOLINE ALY
INDIANAPOLIS IN
46222-5933
US

IV. Provider business mailing address

203 LUCKY LN
PENDLETON IN
46064-9190
US

V. Phone/Fax

Practice location:
  • Phone: 317-646-0768
  • Fax:
Mailing address:
  • Phone: 765-635-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number6233-9863
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: