Provider Demographics
NPI:1174712855
Name:DR. THOMAS C SCHERICH
Entity type:Organization
Organization Name:DR. THOMAS C SCHERICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-639-2090
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-0549
Mailing Address - Country:US
Mailing Address - Phone:928-567-6458
Mailing Address - Fax:928-567-6459
Practice Address - Street 1:452 W FINNIE FLATS RD
Practice Address - Street 2:STE O
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7298
Practice Address - Country:US
Practice Address - Phone:928-567-6458
Practice Address - Fax:928-567-6459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ451261Medicaid
AZG80992Medicare UPIN
AZZ66170Medicare PIN