Provider Demographics
NPI:1235253717
Name:SCHWARTZKOPF, JOEL W
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:W
Last Name:SCHWARTZKOPF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:W,
Other - Last Name:SCHWARTZKOPF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1127 SW CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5887
Mailing Address - Country:US
Mailing Address - Phone:307-575-1300
Mailing Address - Fax:
Practice Address - Street 1:WASHINGTON BUILDING 642303
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99164-7282
Practice Address - Country:US
Practice Address - Phone:509-335-3575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY408363A00000X
COPA.0002917363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11184337Medicaid
WYW21181Medicare PIN
CO11184337Medicaid
Q76852Medicare UPIN