Provider Demographics
NPI:1275706491
Name:MARK J SCHULD MD PC
Entity Type:Organization
Organization Name:MARK J SCHULD MD PC
Other - Org Name:HERITAGE FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHULD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-894-2304
Mailing Address - Street 1:7500 STATE ROAD 46
Mailing Address - Street 2:PO BOX 537
Mailing Address - City:RILEY
Mailing Address - State:IN
Mailing Address - Zip Code:47871
Mailing Address - Country:US
Mailing Address - Phone:812-894-2304
Mailing Address - Fax:812-894-3604
Practice Address - Street 1:7500 STATE ROAD 46
Practice Address - Street 2:
Practice Address - City:RILEY
Practice Address - State:IN
Practice Address - Zip Code:47871
Practice Address - Country:US
Practice Address - Phone:812-894-2304
Practice Address - Fax:812-894-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045428A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDC1530OtherPALMETTO GBA
IN=========OtherHEALTHLINK
INDC1530OtherPALMETTO GBA
IN=========OtherFIRST HEALTH
IN=========OtherTRICARE