Basic Information
| Provider Information | |||||||||
| NPI: | 1851679856 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCHEUBER ROAD EMERGENCY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3916 STATE ST | ||||||||
| Address2: | #300 | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931055602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002305160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 914 S SCHEUBER RD | ||||||||
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| City: | CENTRALIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985319027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603308516 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2011 | ||||||||
| LastUpdateDate: | 08/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | ISCOVICH | ||||||||
| AuthorizedOfficialFirstName: | ANGEL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8055633011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.