Basic Information
| Provider Information | |||||||||
| NPI: | 1306984679 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHUTT | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | C | ||||||||
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| NameSuffix: | |||||||||
| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4780 N JOSEY LANE | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724921334 | ||||||||
| FaxNumber: | 9723952219 | ||||||||
| Practice Location | |||||||||
| Address1: | 4780 N JOSEY LANE | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724921334 | ||||||||
| FaxNumber: | 9723952219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 09/23/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085002869 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA05910 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0739010002 | 01 | IL | MEDICARE NSC | OTHER | 6484850003 | 01 | TX | MEDICARE NSC - EFFECT 02/01/2011 | OTHER | MS1530650 | 01 | IL | DEA | OTHER | 0739010003 | 01 | IL | MEDICARE NSC | OTHER | 208592 | 01 | IL | MEDICARE LOCALITY 99 | OTHER | 835N08 | 01 | TX | BC/BS TX - EFFECT 02/01/2011 | OTHER | 8Y9532 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | P00477787 | 01 | IL | RAILROAD MEDICARE PTAN | OTHER | 208887 | 01 | IL | MEDICARE LOCALITY 15 | OTHER | P00935332 | 01 | TX | RAILROAD MEDICARE | OTHER | 0739010008 | 01 | IL | MEDICARE NSC | OTHER | 0739010006 | 01 | IL | MEDICARE NSC | OTHER | CD4744 | 01 | IL | RAILROAD MEDICARE GROUP # | OTHER | 0739010001 | 01 | IL | MEDICARE NSC | OTHER | 0739010004 | 01 | IL | MEDICARE NSC | OTHER | 0739010005 | 01 | IL | MEDICARE NSC | OTHER | 0739010010 | 01 | IL | MEDICARE NSC | OTHER | TXB128138 | 01 | TX | MEDICARE PART B - EFFECT. 05/03/2011 | OTHER | 085002869 | 01 | IL | ST. OF IL LICENSE | OTHER | 385001696 | 01 | IL | CONTROLLED SUBSTANCE | OTHER |