Basic Information
| Provider Information | |||||||||
| NPI: | 1770591760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHAFER | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751649 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437891620 | ||||||||
| FaxNumber: | 8437242440 | ||||||||
| Practice Location | |||||||||
| Address1: | 2145 HENRY TECKLENBURG DR STE 220 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294145894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437238823 | ||||||||
| FaxNumber: | 8437666551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 897 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 897 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | 897 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 1225006760 | 01 | SC | GROUP NPI # | OTHER | 20000499 | 01 | SC | GROUP SELECT HEALTH PROVIDER # | OTHER | 56162 | 01 | SC | MEDCOST PAYOR ID | OTHER | 57-0634057 | 01 | SC | GROUP TAX ID # | OTHER | PA0971 | 01 | SC | GROUP MEDICAID # | OTHER | 042299001 | 01 | SC | GROUP DMERC # | OTHER | CD28777 | 01 | SC | GROUP MEDICARE RAILROAD # | OTHER | 1326287434 | 01 | SC | GROUP MEDICARE DME NPI # | OTHER | 1701 | 01 | SC | GROUP MEDICARE PIN | OTHER | 20076508 | 01 | SC | GROUP SELECT HEALTH DME # | OTHER | 461555 | 01 | SC | GROUP MEDICARE DME # | OTHER |