MEDICARE: DR. JIMMIE C. SCHMIDT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12496	TX

General Provider Information

NPI Number	:	1205898624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMIE C. SCHMIDT DDS

Provider Business Mailing Address
First Line	:	600 CAISSON HILL ROAD
Second Line	:	US ARMY DENTAL ACTIVITY
City	:	FORT RILEY
State	:	KS
Zip	:	66442-5043
Country	:	US
Telephone Number	:	785-239-7226
Fax Number	:	785-239-7245

Provider Business Practice Location Address
First Line	:	600 CAISSON HILL RD
Second Line	:
City	:	FORT RILEY
State	:	KS
Zip	:	66442-7037
Country	:	US
Telephone Number	:	785-239-7226
Fax Number	:	785-239-7226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	06/16/2009

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