Basic Information
Provider Information | |||||||||
NPI: | 1437451424 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHNATZ | ||||||||
FirstName: | REBECCA | ||||||||
MiddleName: | HEUER | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 97 GREAT TEAYS BLVD | ||||||||
Address2: | SUITE 6 | ||||||||
City: | SCOTT DEPOT | ||||||||
State: | WV | ||||||||
PostalCode: | 255609815 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3047576999 | ||||||||
FaxNumber: | 3047573252 | ||||||||
Practice Location | |||||||||
Address1: | 97 GREAT TEAYS BLVD | ||||||||
Address2: | SUITE 6 | ||||||||
City: | SCOTT DEPOT | ||||||||
State: | WV | ||||||||
PostalCode: | 255609815 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3047576999 | ||||||||
FaxNumber: | 3047573252 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/23/2010 | ||||||||
LastUpdateDate: | 08/13/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 2864 | WV | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 002711304 | 01 |   | HIGHMARK BCBS | OTHER | 3810025085 | 05 | WV |   | MEDICAID | 8990911 | 01 |   | CIGNA | OTHER |