Provider Demographics
NPI:1104822089
Name:SCHWEIKERT, TED WILBUR (CRNA)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:WILBUR
Last Name:SCHWEIKERT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 WEST THIRD STREET
Mailing Address - Street 2:VA MEDICAL CENTER
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45428
Mailing Address - Country:US
Mailing Address - Phone:804-349-3045
Mailing Address - Fax:937-987-0109
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:804-349-3045
Practice Address - Fax:937-987-0109
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166000367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010146836Medicaid
VA007051C88Medicare ID - Type Unspecified
VA010146836Medicaid