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1063415404

NPI Code Detail

MEDICARE: DR. CHRISTINE C SCHALLER MD

MEDICARE: DR. CHRISTINE C SCHALLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	M9461	ID

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00884048	OTHER	ID	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0265455	OTHER	WA	LABOR & INDUSTRIES
2	1063415404	OTHER	ID	REGENCE BLUESHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	78399	OTHER	ID	BC/ID

General Provider Information

NPI Number	:	1063415404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE C SCHALLER MD

Provider Business Mailing Address
First Line	:	77 POPLAR DR
Second Line	:
City	:	GRANGEVILLE
State	:	ID
Zip	:	83530-5347
Country	:	US
Telephone Number	:	208-983-3744
Fax Number	:	208-298-4520

Provider Business Practice Location Address
First Line	:	2315 8TH ST
Second Line	:
City	:	LEWISTON
State	:	ID
Zip	:	83501-7301
Country	:	US
Telephone Number	:	208-983-5120
Fax Number	:	208-983-5404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	11/01/2012

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Directions to “ DR. CHRISTINE C SCHALLER MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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