Provider Demographics
NPI:1558620286
Name:SCHNEIDER FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:SCHNEIDER FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-845-1670
Mailing Address - Street 1:5150 N 16TH ST
Mailing Address - Street 2:STE B232
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3990
Mailing Address - Country:US
Mailing Address - Phone:602-845-1670
Mailing Address - Fax:602-445-6871
Practice Address - Street 1:5060 N 40TH ST
Practice Address - Street 2:STE 108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2145
Practice Address - Country:US
Practice Address - Phone:602-845-1670
Practice Address - Fax:602-445-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ90176Medicare PIN