Basic Information
| Provider Information | |||||||||
| NPI: | 1720144025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHIFFBAUER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4046 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658084046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172692000 | ||||||||
| FaxNumber: | 4172692038 | ||||||||
| Practice Location | |||||||||
| Address1: | 3443 S. NATIONAL AVW | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658077308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172692000 | ||||||||
| FaxNumber: | 4172692038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 11/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 12884 | NE | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 2012036548 | MO | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 415 | 01 | NE | MIDLANDS CHOICE | OTHER | 1201189 | 05 | NE | MEDICAID | 1201192 | 05 | NE | MEDICAID | 1201119 | 05 | NE | MEDICAID | 1201190 | 05 | NE | MEDICAID | 2950006 | 05 | IA | MEDICAID | 1201188 | 05 | NE | MEDICAID | 3950006 | 05 | IA | MEDICAID | 1201191 | 05 | NE | MEDICAID | 1950006 | 05 | IA | MEDICAID | 1201132 | 05 | NE | MEDICAID | 1201193 | 05 | NE | MEDICAID | 32064 | 01 | NE | BCBS OF NE | OTHER |