Provider Demographics
NPI:1548363260
Name:DERMATOLOGY CARE PC
Entity type:Organization
Organization Name:DERMATOLOGY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:HOLZMEYER
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-299-3376
Mailing Address - Street 1:1202 E CANVASBACK DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5305
Mailing Address - Country:US
Mailing Address - Phone:812-299-3376
Mailing Address - Fax:812-299-7326
Practice Address - Street 1:1202 E CANUASBACK DR
Practice Address - Street 2:
Practice Address - City:TERRA HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802
Practice Address - Country:US
Practice Address - Phone:812-299-3376
Practice Address - Fax:812-299-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN162970Medicare PIN