Provider Demographics
NPI:1396829347
Name:MARY E. SCHMIEDER DO. FACEP, INC
Entity Type:Organization
Organization Name:MARY E. SCHMIEDER DO. FACEP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHMIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-278-2246
Mailing Address - Street 1:PO BOX 14379
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32238-1379
Mailing Address - Country:US
Mailing Address - Phone:904-278-2246
Mailing Address - Fax:904-278-2247
Practice Address - Street 1:1543 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4535
Practice Address - Country:US
Practice Address - Phone:904-278-2246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X
FLOS0004991208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1598739641OtherINDIV NPI
FL1598739641OtherINDIV NPI
FL82832TMedicare ID - Type UnspecifiedINDIV LEGACY NO.MEDICARE
FLK1591Medicare ID - Type UnspecifiedGROUP LEGACY NUMBER-MCR