Provider Demographics
NPI:1841320413
Name:RICK R SCHMIDT MD PC
Entity type:Organization
Organization Name:RICK R SCHMIDT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-527-7555
Mailing Address - Street 1:1401 N 4TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-1806
Mailing Address - Country:US
Mailing Address - Phone:405-527-7555
Mailing Address - Fax:405-527-7596
Practice Address - Street 1:1800 N GREEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1630
Practice Address - Country:US
Practice Address - Phone:405-527-7555
Practice Address - Fax:833-797-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK444666221001OtherBLUE CROSS BLUE SHIELD
OK100113440AMedicaid