=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780979880
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARLENE G. SCHLUMBOHM, DO, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2011
-----------------------------------------------------
Last Update Date | 06/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4205 BELFORT RD STE. 3004
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-1471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-482-1083
-----------------------------------------------------
Fax | 904-482-1089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4205 BELFORT RD STE. 3004
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-1471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-482-1083
-----------------------------------------------------
Fax | 904-482-1089
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY PRACTICE PHYSICIAN
-----------------------------------------------------
Name | MS. ARLENE G SCHLUMBOHM
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 904-482-1083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------