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General NPI Number Information
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NPI Number | 1891454013
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Entity Type | Organization
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Legal Business Name | SCHNEIDER MOBILE CLINIC LLC
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 6408 EDGE WATER DR
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City | WATERLOO
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State | IL
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Zip | 62298-3059
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Country | US
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Telephone | 618-514-0427
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Fax |
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Provider Business Mailing Address
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Address Line | 6408 EDGE WATER DR
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City | WATERLOO
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State | IL
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Zip | 62298-3059
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Country | US
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Telephone | 618-514-0427
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FRANCIS SCHNEIDER
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Credential |
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Telephone | 618-719-6981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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