Healthcare Provider Details

I. General information

NPI: 1497682397
Provider Name (Legal Business Name): VINCENT JOHNATHAN SCHMIDT MEDICAL STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 SAINT JOHNS BLVD
JOPLIN MO
64804-1598
US

IV. Provider business mailing address

2521 S TYLER AVE
JOPLIN MO
64804-1549
US

V. Phone/Fax

Practice location:
  • Phone: 417-208-0630
  • Fax:
Mailing address:
  • Phone: 402-705-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: