1841295698 NPI number — JONNA LEIGH SCHMIDT MD

Table of content: JONNA LEIGH SCHMIDT MD (NPI 1841295698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841295698 NPI number — JONNA LEIGH SCHMIDT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMIDT
Provider First Name:
JONNA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1841295698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/18/2006
NPI Reactivation Date:
03/29/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
456 CROSS ST
Provider Second Line Business Mailing Address:
PO BOX 270
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49247-9706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-448-8918
Provider Business Mailing Address Fax Number:
517-448-4085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
456 CROSS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49247-9706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-448-8918
Provider Business Practice Location Address Fax Number:
517-448-4085
Provider Enumeration Date:
06/17/2005

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:  JS406858 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3263838 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104600681 . This is a "BCBSM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 03618 . This is a "PARAMOUNT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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