1407951478 NPI number — STEPHEN A. SCHMIDT MD SC

Table of content: (NPI 1407951478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407951478 NPI number — STEPHEN A. SCHMIDT MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN A. SCHMIDT MD SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1407951478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W. LINCOLN
Provider Second Line Business Mailing Address:
STE 402
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-277-0475
Provider Business Mailing Address Fax Number:
618-277-0593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62220-1987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-277-0475
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMIDT
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
618-277-0475

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  036-065962 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100008034 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101342 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8006472240 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10687 . This is a "ESSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3067456 001 . This is a "CIGNA PAL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P40682181 . This is a "BCE EMERGIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29-07321 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34684 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200951721 . This is a "MUTUAL OF OMAHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4000960 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4060 . This is a "SOUTHER IL HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8200489 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036065962 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1452539 . This is a "UMWA - FUNDS" identifier . This identifiers is of the category "OTHER".




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