Provider Demographics
NPI:1780679068
Name:SCHUG, ANDREW J (PAC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:SCHUG
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-7301
Mailing Address - Country:US
Mailing Address - Phone:208-746-1383
Mailing Address - Fax:208-746-6348
Practice Address - Street 1:2315 8TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-7301
Practice Address - Country:US
Practice Address - Phone:208-746-1383
Practice Address - Fax:208-746-6348
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA446363A00000X
WAPA10004517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1780679068OtherREGENCE BLUE SHIELD
IDPAWB1OtherBCI
WA1018848Medicaid
ID1780679068Medicaid
WAP00749511OtherRR MEDICARE
IDP00815198OtherRR MEDICARE
WAP00749511OtherRR MEDICARE
WA1018848Medicaid
WA8800264Medicare PIN