1568579498 NPI number — MR. KEVIN KIRKWOOD SCHMIDT PA-C

Table of content: MR. KEVIN KIRKWOOD SCHMIDT PA-C (NPI 1568579498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568579498 NPI number — MR. KEVIN KIRKWOOD SCHMIDT PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMIDT
Provider First Name:
KEVIN
Provider Middle Name:
KIRKWOOD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1568579498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10767 ILLINOIS ST STE 3000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-8972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-817-1200
Provider Business Mailing Address Fax Number:
317-817-1220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10767 ILLINOIS ST STE 3000
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-8972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-817-1200
Provider Business Practice Location Address Fax Number:
317-817-1220
Provider Enumeration Date:
08/24/2006

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: 363AM0700X , with the licence number:  10000460A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1041479 . This is a "NCCPA CERTIFICATION #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 970023217 . This is a "MEDICARE RAIL ROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000290615 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000596241 . This is a "ANTHEM - CIPA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 11480220 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000603577 . This is a "ANTHEM - TIPTON HOSPITAL" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 10000460A . This is a "INDIANA LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 256870Q . This is a "MEDICARE PIN - CIPA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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