1649257866 NPI number — DR. GREG N SMITH MD

Table of content: DR. GREG N SMITH MD (NPI 1649257866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649257866 NPI number — DR. GREG N SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
GREG
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649257866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 STANLEY GAULT PKWY
Provider Second Line Business Mailing Address:
STE 129
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-5176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-253-4917
Provider Business Mailing Address Fax Number:
502-489-5751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 KRESGE WAY
Provider Second Line Business Practice Location Address:
STE 56
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-248-4789
Provider Business Practice Location Address Fax Number:
812-248-4773
Provider Enumeration Date:
12/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  25764 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 130006170 . This is a "MEDICARE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64257645 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1049112 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2432393000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100373840 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000046155 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com