Basic Information
| Provider Information | |||||||||
| NPI: | 1538109855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHMIDT | ||||||||
| FirstName: | ROY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 STONEBRIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383052042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316602056 | ||||||||
| FaxNumber: | 7316619092 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 STONEBRIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383052042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316602056 | ||||||||
| FaxNumber: | 7316619092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 04/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD22099 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | MD22099 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 174400000X | 22099 | TN | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 3380640 | 05 | TN | MEDICAID | 030670000 | 01 | KY | BLACK LUNG | OTHER | 000000378004 | 01 | KY | ANTHEM | OTHER | C20829 | 01 | KY | CUMBERLAND HEALTHCARE INC | OTHER | 50007501 | 01 | KY | PASSPORT HEALTH PLAN | OTHER | 64095367 | 05 | KY | MEDICAID |