Provider Demographics
NPI:1831108687
Name:SCHMIDT, THOMAS P
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7911 ZACHARY CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-3327
Mailing Address - Country:US
Mailing Address - Phone:402-464-8774
Mailing Address - Fax:
Practice Address - Street 1:1730 S 70TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1613
Practice Address - Country:US
Practice Address - Phone:402-489-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE454000363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470703083-13Medicaid
NER80770Medicare UPIN
NE470703083-13Medicaid