MEDICARE: CHARLES SCHROEDER 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	207V00000X	Obstetrics & Gynecology Physician	28382	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	3720237	OTHER		GRP MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	4063853	OTHER	BLUE CARE - TNCARE
2	5504519	OTHER	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4063853	OTHER	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	TN0101	OTHER	JOHN DEERE

General Provider Information

NPI Number	:	1669471512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES SCHROEDER MD

Provider Business Mailing Address
First Line	:	9330 PARK WEST BLVD
Second Line	:	STE 502
City	:	KNOXVILLE
State	:	TN
Zip	:	37923
Country	:	US
Telephone Number	:	865-531-3303
Fax Number	:	865-531-1272

Provider Business Practice Location Address
First Line	:	9330 PARK WEST BLVD
Second Line	:	STE 502
City	:	KNOXVILLE
State	:	TN
Zip	:	37923
Country	:	US
Telephone Number	:	865-531-3303
Fax Number	:	865-531-1272

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/08/2007

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