MEDICARE: SCHMITZ FAMILY PRACTICE AND RURAL HEALTH, PLLC

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	261QP2300X	Primary Care Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5G612	OTHER	AR	MEDICARE PTAN
3	5J293	OTHER	AR	MEDICARE - BCBS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285949495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHMITZ FAMILY PRACTICE AND RURAL HEALTH, PLLC

Provider Business Mailing Address
First Line	:	1006 E MAIN ST
Second Line	:
City	:	CHARLESTON
State	:	AR
Zip	:	72933-9388
Country	:	US
Telephone Number	:	479-965-7702
Fax Number	:	479-965-2180

Provider Business Practice Location Address
First Line	:	1006 E MAIN ST
Second Line	:
City	:	CHARLESTON
State	:	AR
Zip	:	72933-9388
Country	:	US
Telephone Number	:	479-965-7702
Fax Number	:	479-965-2180

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES L. SCHMITZ
Credential	:	D.O.
Telephone Number	:	479-965-7702

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	11/23/2010

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