Provider Demographics
NPI:1457303992
Name:SCHAEFER, CATHERINE A (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTENTION PATIENT ACCOUNTING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:843-234-8958
Practice Address - Street 1:8004 MYRTLE TRACE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8945
Practice Address - Country:US
Practice Address - Phone:843-234-8939
Practice Address - Fax:843-234-8959
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC185132Medicaid
SC185132Medicaid
SC185132OtherSC INDIVIDUAL MEDICAID LEGACY # FOR CONWAY HOSP COMMUNITY SERVICES EMPLOYMENT
SC7844OtherCONWAY HOSPITAL COMMUNITY SERVICES MEDICARE PTAN
SCGP6122Medicaid
SCGP3564Medicaid
SC185132Medicaid
SCGP6276Medicaid
SCGP6276Medicaid
SCGP3564Medicaid