Provider Demographics
NPI:1629471081
Name:REIFSCHNEIDER, SCOTT (PA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:REIFSCHNEIDER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-0406
Mailing Address - Country:US
Mailing Address - Phone:308-754-4421
Mailing Address - Fax:
Practice Address - Street 1:1113 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:NE
Practice Address - Zip Code:68873-1546
Practice Address - Country:US
Practice Address - Phone:308-754-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC47285776Medicare PIN