Provider Demographics
NPI:1437206547
Name:CHARLES E SCHNEIDER DPM PC
Entity Type:Organization
Organization Name:CHARLES E SCHNEIDER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-543-2476
Mailing Address - Street 1:1619 N GREEN WOOD ST
Mailing Address - Street 2:# 300
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2657
Mailing Address - Country:US
Mailing Address - Phone:719-543-2476
Mailing Address - Fax:719-543-2479
Practice Address - Street 1:1619 N GREEN WOOD ST
Practice Address - Street 2:# 300
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2657
Practice Address - Country:US
Practice Address - Phone:719-543-2476
Practice Address - Fax:719-543-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO282213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01002823Medicaid
COCF5903Medicare ID - Type Unspecified
T60222Medicare UPIN