Provider Demographics
NPI:1407951478
Name:STEPHEN A. SCHMIDT MD SC
Entity Type:Organization
Organization Name:STEPHEN A. SCHMIDT MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-277-0475
Mailing Address - Street 1:300 W. LINCOLN
Mailing Address - Street 2:STE 402
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220
Mailing Address - Country:US
Mailing Address - Phone:618-277-0475
Mailing Address - Fax:618-277-0593
Practice Address - Street 1:300 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1987
Practice Address - Country:US
Practice Address - Phone:618-277-0475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-065962207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
100008034OtherMEDICARE RAILROAD
101342OtherHEALTHLINK
8006472240OtherMERCY
IL10687OtherESSE
IL3067456 001OtherCIGNA PAL
P40682181OtherBCE EMERGIS
29-07321OtherUNITED HEALTH CARE
IL34684OtherGROUP HEALTH PLAN
200951721OtherMUTUAL OF OMAHA
4000960OtherAETNA
4060OtherSOUTHER IL HEALTH CARE
IL8200489OtherBLUE CROSS/BLUE SHIELD
IL036065962Medicaid
1452539OtherUMWA - FUNDS
4060OtherSOUTHER IL HEALTH CARE