Basic Information
| Provider Information | |||||||||
| NPI: | 1407837362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHLABACH | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CARLYLE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHLABACH | ||||||||
| OtherFirstName: | CARLYLE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1507 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GATESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765281024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2548658251 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3137 W INDIAN SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850174069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023255570 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 05/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | M5489 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 24456 | AZ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 01037080A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | MD20060005 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 01037080A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 24456 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 360397 | 05 | AZ | MEDICAID | 75208300 | 05 | NM | MEDICAID | 360397 | 05 | IN | MEDICAID |