Healthcare Provider Details

I. General information

NPI: 1275686883
Provider Name (Legal Business Name): SCHEIDLER RURAL HEALTH CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SOUTH BYP
KENNETT MO
63857-3252
US

IV. Provider business mailing address

301 SOUTH BYP
KENNETT MO
63857-3252
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-0900
  • Fax: 573-888-9588
Mailing address:
  • Phone: 573-888-0900
  • Fax: 573-888-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEFAN SCHEIDLER
Title or Position: OWNER
Credential: M.D.
Phone: 57388808900