=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235115452
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGE JAY SCHERER OTR/L
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 149 HART ST 82 MEDICAL GROUP/CREDENTIALS
-----------------------------------------------------
City | SHEPPARD AFB
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76311-3482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-676-7049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6700 APACHE TRL
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76310-2702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-867-2150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171000000X
-----------------------------------------------------
Taxonomy Name | Military Health Care Provider
-----------------------------------------------------
License Number | 545
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------