Healthcare Provider Details

I. General information

NPI: 1427096262
Provider Name (Legal Business Name): MATTHEW E. SCHANTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S MILITARY ST
LORETTO TN
38469-2101
US

IV. Provider business mailing address

PO BOX 307
LAWRENCEBURG TN
38464-0307
US

V. Phone/Fax

Practice location:
  • Phone: 931-853-6136
  • Fax: 931-853-6137
Mailing address:
  • Phone: 931-853-6136
  • Fax: 931-853-6137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37065TN
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: