Basic Information
| Provider Information | |||||||||
| NPI: | 1639141179 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHNEIDER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 S MINNESOTA AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571053761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 W 69TH ST | ||||||||
| Address2: | STE 500 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571088170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227580 | ||||||||
| FaxNumber: | 6053227579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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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 | 2084P0804X | 3666 | SD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 12242 | 05 | ND | MEDICAID | 25266 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 260040364 | 01 | SD | RR MEDICARE | OTHER | 57108D003 | 01 | SD | WPS TRICARE | OTHER | 769191017550 | 01 | SD | PREFERRED ONE | OTHER | 10378 | 01 | SD | MIDLANDS CHOICE | OTHER | 512428 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 7100932 | 05 | SD | MEDICAID | 92411422904 | 01 | MN | PRIMEWEST | OTHER | HP24841 | 01 | SD | HEALTHPARTNERS | OTHER | 0002827 | 01 | SD | BLUE CROSS | OTHER | 0033303 | 05 | MT | MEDICAID | 1908517 | 05 | IA | MEDICAID | 296265900 | 05 | MN | MEDICAID | 3666 | 01 | SD | DAKOTACARE | OTHER | 46022474340 | 05 | NE | MEDICAID | 3T022SC | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER |