Provider Demographics
NPI:1275686883
Name:SCHEIDLER RURAL HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:SCHEIDLER RURAL HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:5738-880-8900
Mailing Address - Street 1:301 SOUTH BYP
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3252
Mailing Address - Country:US
Mailing Address - Phone:573-888-0900
Mailing Address - Fax:573-888-9588
Practice Address - Street 1:301 SOUTH BYP
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3252
Practice Address - Country:US
Practice Address - Phone:573-888-0900
Practice Address - Fax:573-888-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015184OtherMEDICARE PART B
MO000015184OtherMEDICARE PART B