=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043826969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN PAUL SCHAEFFER HIS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2020
-----------------------------------------------------
Last Update Date | 09/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 N WITCHDUCK RD STE 103
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-1947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-687-8324
-----------------------------------------------------
Fax | 757-222-5991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 N WITCHDUCK RD STE 103
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-1947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-687-8324
-----------------------------------------------------
Fax | 757-222-5991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146N00000X
-----------------------------------------------------
Taxonomy Name | Basic Emergency Medical Technician
-----------------------------------------------------
License Number | B201502220
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 2101002458
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------