Provider Demographics
NPI:1679585848
Name:CYGNET SCHROEDER DO PA
Entity type:Organization
Organization Name:CYGNET SCHROEDER DO PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYGNET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:479-478-8555
Mailing Address - Street 1:PO BOX 3363
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72913-3363
Mailing Address - Country:US
Mailing Address - Phone:479-478-8555
Mailing Address - Fax:
Practice Address - Street 1:1401 S J ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5158
Practice Address - Country:US
Practice Address - Phone:479-478-8555
Practice Address - Fax:479-478-8568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4158225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149716002Medicaid
250014112OtherMEDICARE RAIL ROAD
250014112OtherMEDICARE RAIL ROAD
AR149716002Medicaid