Provider Demographics
NPI:1487623930
Name:SCHMIDT, MARTHA ANN (BC-HIS)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ANN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 BOUNDRY ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47327-1517
Mailing Address - Country:US
Mailing Address - Phone:765-478-3854
Mailing Address - Fax:
Practice Address - Street 1:140 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE CITY
Practice Address - State:IN
Practice Address - Zip Code:47327-1219
Practice Address - Country:US
Practice Address - Phone:765-478-9255
Practice Address - Fax:765-478-9265
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17000729A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000230552OtherBLUE CROSS BLUE SHIELD