Provider Demographics
NPI:1700597580
Name:SCHOONOVER, TODD ALLEN
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALLEN
Last Name:SCHOONOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 SE 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-7170
Mailing Address - Country:US
Mailing Address - Phone:405-248-6220
Mailing Address - Fax:
Practice Address - Street 1:12400 SE 15TH ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-7170
Practice Address - Country:US
Practice Address - Phone:405-248-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
88-2887792OtherIRS