Provider Demographics
NPI:1407283542
Name:PETER M. SCHMID, DO PC LLC
Entity Type:Organization
Organization Name:PETER M. SCHMID, DO PC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SCHMID
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-651-6770
Mailing Address - Street 1:1305 SUMNER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3271
Mailing Address - Country:US
Mailing Address - Phone:303-651-6770
Mailing Address - Fax:303-651-6794
Practice Address - Street 1:1305 SUMNER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3270
Practice Address - Country:US
Practice Address - Phone:303-651-6770
Practice Address - Fax:303-651-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32368207Y00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01323682Medicaid
COE93634Medicare UPIN