Provider Demographics
NPI:1023296159
Name:SCHROECK, DEBRA BECK (MS, PA-C)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:BECK
Last Name:SCHROECK
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ELLEN
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 STETSON ST
Mailing Address - Street 2:SUITE 3200 ML 0516
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2492
Mailing Address - Country:US
Mailing Address - Phone:513-558-0956
Mailing Address - Fax:513-558-3399
Practice Address - Street 1:260 STETSON ST
Practice Address - Street 2:SUITE 3200 ML 0516
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2492
Practice Address - Country:US
Practice Address - Phone:513-558-0956
Practice Address - Fax:513-558-3399
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1099363A00000X
OH50. 002262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00866124OtherRAILROAD MEDICARE
KYP00799583OtherRAILROAD MEDICARE
KY7100088670Medicaid
KY7100088670Medicaid
KY0974316Medicare PIN
KY008580049Medicare PIN