1174504682 NPI number — MARY COLETTE SCHMIDT M.D.

Table of content: ASHLEY CHRISTINA FLAQUER (NPI 1992559074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174504682 NPI number — MARY COLETTE SCHMIDT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMIDT
Provider First Name:
MARY
Provider Middle Name:
COLETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHMIDT-TURNER
Provider Other First Name:
MARY
Provider Other Middle Name:
COLETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174504682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 611
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORISSANT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63032-0611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-922-4048
Provider Business Mailing Address Fax Number:
636-333-4510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 PARKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACK JACK
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63033-4266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-922-4048
Provider Business Practice Location Address Fax Number:
636-333-4510
Provider Enumeration Date:
11/10/2005

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: 207R00000X , with the licence number:  36735 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000010050 . This is a "ESSENCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 24287 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: A14103 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 138775 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4401357 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 101339 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0400603 . This is a "UHC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 202507604 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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