Healthcare Provider Details

I. General information

NPI: 1235271107
Provider Name (Legal Business Name): CHRISTOPHER PHILIP SCHROEDER SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E. BROADWAY
JACKSON WY
83001
US

IV. Provider business mailing address

PO BOX 9193
JACKSON WY
83002-9193
US

V. Phone/Fax

Practice location:
  • Phone: 208-525-2090
  • Fax: 208-525-2662
Mailing address:
  • Phone: 208-525-2090
  • Fax: 208-525-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: