Provider Demographics
NPI:1881864163
Name:ROBERT J. SCHULTE, JR. PA
Entity Type:Organization
Organization Name:ROBERT J. SCHULTE, JR. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHULTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:701-237-0710
Mailing Address - Street 1:2800 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6030
Mailing Address - Country:US
Mailing Address - Phone:701-237-0710
Mailing Address - Fax:701-237-0615
Practice Address - Street 1:2800 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6030
Practice Address - Country:US
Practice Address - Phone:701-237-0710
Practice Address - Fax:701-237-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND349261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND018074Medicaid
MN068725100Medicaid
NDN711277Medicare PIN
NDDB7222Medicare PIN