Provider Demographics
NPI:1174807697
Name:REBECCA J SCHOETTLE PEDIATRICS INC
Entity type:Organization
Organization Name:REBECCA J SCHOETTLE PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHOETTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-353-6500
Mailing Address - Street 1:1735 27TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2677
Mailing Address - Country:US
Mailing Address - Phone:740-353-6500
Mailing Address - Fax:740-354-5389
Practice Address - Street 1:1735 27TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2677
Practice Address - Country:US
Practice Address - Phone:740-353-6500
Practice Address - Fax:740-354-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048393208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0599213Medicaid