Provider Demographics
NPI:1891454013
Name:SCHNEIDER MOBILE CLINIC LLC
Entity Type:Organization
Organization Name:SCHNEIDER MOBILE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-719-6981
Mailing Address - Street 1:6408 EDGE WATER DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-3059
Mailing Address - Country:US
Mailing Address - Phone:618-514-0427
Mailing Address - Fax:
Practice Address - Street 1:6408 EDGE WATER DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-3059
Practice Address - Country:US
Practice Address - Phone:618-514-0427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center