=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619791563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZACHARY SCHOTT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2024
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 PROFESSIONAL PL # 103
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26330-4599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-969-4885
-----------------------------------------------------
Fax | 304-853-5859
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 207 GANDALF RD
-----------------------------------------------------
City | MASONTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26542-9023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | ZACHARY SCHOTT
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 304-518-1861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------