Basic Information
| Provider Information | |||||||||
| NPI: | 1164413225 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOHN SCHNEIDER JR MD PC | ||||||||
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| OtherOrganizationName: | NORTHERN ROCKIES NEURO-SPINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 449 MOUNTAIN VIEW ST | ||||||||
| Address2: | |||||||||
| City: | POWELL | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824352232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077544559 | ||||||||
| FaxNumber: | 3077547733 | ||||||||
| Practice Location | |||||||||
| Address1: | 2877 OVERLAND AVE | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591027469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066518197 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 12/05/2007 | ||||||||
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| AuthorizedOfficialLastName: | SCHNEIDER | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4066518197 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 05777001 | 01 | WY | BLUE CROSS BLUE SHEILD | OTHER |