Provider Demographics
NPI:1871880682
Name:AMY BLACKWELL SCHUNEMEYER
Entity type:Organization
Organization Name:AMY BLACKWELL SCHUNEMEYER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BLACKWELL
Authorized Official - Last Name:SCHUNEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:337-365-4195
Mailing Address - Street 1:398 N LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2843
Mailing Address - Country:US
Mailing Address - Phone:337-365-4195
Mailing Address - Fax:337-365-9557
Practice Address - Street 1:398 N LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2843
Practice Address - Country:US
Practice Address - Phone:337-365-4195
Practice Address - Fax:337-365-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5DV29Medicare PIN
LA6609220001Medicare NSC