Provider Demographics
NPI:1598769457
Name:SCHMIDT, JEFFREY R (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-0932
Mailing Address - Country:US
Mailing Address - Phone:605-996-8171
Mailing Address - Fax:605-996-8171
Practice Address - Street 1:501 S OHLMAN ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-3108
Practice Address - Country:US
Practice Address - Phone:605-996-8171
Practice Address - Fax:605-996-8171
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD147213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6800422Medicaid
SD9152040Medicaid
SD22403OtherSIOUX VALLEY HEALTH PLANS
SD1642OtherAVERA HEALTH PLANS
SD480020837OtherRAILROAD MEDICARE
SD480020837OtherRAILROAD MEDICARE
SD5059930001Medicare ID - Type UnspecifiedMEDICARE DURABLE GOODS
SDS4386Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
SD6800422Medicaid