1619138005 NPI number — GREGORY C SCHMIEDER MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619138005 NPI number — GREGORY C SCHMIEDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMIEDER
Provider First Name:
GREGORY
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619138005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-9490
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3999 DUTCHMANS LN
Provider Second Line Business Practice Location Address:
MEDICAL PLAZA 1, SUITE 1H
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-636-7472
Provider Business Practice Location Address Fax Number:
502-636-7130
Provider Enumeration Date:
06/19/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  42654 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 42654 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200959490 . This is a "ANTHEM INDIANA MEDICAID- CARDIOTHORACIC SURGERY OF LOUISVILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3725700000 . This is a "PASSPORT ADVANTAGE- CARDIOTHORACIC SURGERY OF LOUISVILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 00533138 . This is a "MEDICARE KY- CARDIOTHORACIC SURGERY OF LOUISVILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200959490 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000023036X . This is a "HUMANA- CARDIOTHORACIC SURGERY OF LOUISVILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100074290 . This is a "MEDICAID KY- CARDIOTHORACIC SURGERY OF LOUISVILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 105163 . This is a "SIHO- CARDIOTHORACIC SURGERY OF LOUISVILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50024781 . This is a "PASSPORT- CARDIOTHORACIC SURGERY OF LOUISVILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00733107 . This is a "RAILROAD MEDICARE- CARDIOTHORACIC SURGERY OF LOUISVILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000620831 . This is a "ANTHEM- CARDIOTHORACIC SURGERY OF LOUISVILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 9295388 . This is a "AETNA- CARDIOTHORACIC SURGERY OF LOUISVILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".