1669792420 NPI number — SHAYLA D. CRAYS SMITH, AUD, LTD

Table of content: (NPI 1669792420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669792420 NPI number — SHAYLA D. CRAYS SMITH, AUD, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAYLA D. CRAYS SMITH, AUD, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JANESVILLE HEARING
Provider Other Organization Name Type Code:
3
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:
1669792420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1406 WILLOWBROOK RD STE 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELOIT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53511-6925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-364-4400
Provider Business Mailing Address Fax Number:
608-312-2477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1406 WILLOWBROOK RD STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELOIT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53511-6925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-364-4400
Provider Business Practice Location Address Fax Number:
608-312-2477
Provider Enumeration Date:
06/03/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
SHAYLA
Authorized Official Middle Name:
D.C.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
608-364-4400

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  467-156 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41150300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".