Basic Information
Provider Information
NPI: 1275508368
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHUETZ
FirstName: HUGH
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000 N JEFFERSON ST
Address2:  
City: SAINT JAMES
State: MO
PostalCode: 655591078
CountryCode: US
TelephoneNumber: 5732658840
FaxNumber: 5732658884
Practice Location
Address1: 1000 N JEFFERSON ST
Address2:  
City: SAINT JAMES
State: MO
PostalCode: 655591078
CountryCode: US
TelephoneNumber: 5732658840
FaxNumber: 5732658884
Other Information
ProviderEnumerationDate: 02/22/2006
LastUpdateDate: 06/07/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X111580MOY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
24888160905MO MEDICAID
29657301MOHEALTHLINKOTHER
59684140305MO MEDICAID
43190856001MOPHCSOTHER
551253701MOAETNAOTHER
43190856001MOTRIWESTOTHER
010082801MOUNITED HEALTH CAREOTHER
11753201MOGROUP HEALTH PLANOTHER


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