Provider Demographics
NPI:1174504682
Name:SCHMIDT, MARY COLETTE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:COLETTE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:COLETTE
Other - Last Name:SCHMIDT-TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63032-0611
Mailing Address - Country:US
Mailing Address - Phone:314-922-4048
Mailing Address - Fax:636-333-4510
Practice Address - Street 1:4401 PARKER RD
Practice Address - Street 2:
Practice Address - City:BLACK JACK
Practice Address - State:MO
Practice Address - Zip Code:63033-4266
Practice Address - Country:US
Practice Address - Phone:314-922-4048
Practice Address - Fax:636-333-4510
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36735207R00000X
IL036.132123208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000010050OtherESSENCE
MO24287OtherBCBS
MOA14103OtherMERCY
MO138775OtherGHP
MO4401357OtherAETNA
MO101339OtherHEALTHLINK
MO0400603OtherUHC
MO202507604Medicaid
MO000000010050OtherESSENCE
MO24287OtherBCBS
MO202507604Medicaid