Provider Demographics
NPI:1073795852
Name:PROVIDERS DIRECT, PLLC
Entity Type:Organization
Organization Name:PROVIDERS DIRECT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMALING
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:520-722-2400
Mailing Address - Street 1:5546 E 4TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1452
Mailing Address - Country:US
Mailing Address - Phone:520-722-2400
Mailing Address - Fax:520-323-7531
Practice Address - Street 1:5546 E 4TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1452
Practice Address - Country:US
Practice Address - Phone:520-722-2400
Practice Address - Fax:520-323-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ439013Medicaid
AZZ120694Medicare PIN