MEDICARE: DR. MATTHEW E. SCHANTZ M.D.

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	37065TN	TN

General Provider Information

NPI Number	:	1427096262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW E. SCHANTZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	LAWRENCEBURG
State	:	TN
Zip	:	38464-0307
Country	:	US
Telephone Number	:	931-853-6136
Fax Number	:	931-853-6137

Provider Business Practice Location Address
First Line	:	206 S MILITARY ST
Second Line	:
City	:	LORETTO
State	:	TN
Zip	:	38469-2101
Country	:	US
Telephone Number	:	931-853-6136
Fax Number	:	931-853-6137

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	12/04/2009

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