1740346121 NPI number — MR. DANIEL J. SMILEY CRNA

Table of content: MR. DANIEL J. SMILEY CRNA (NPI 1740346121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740346121 NPI number — MR. DANIEL J. SMILEY CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMILEY
Provider First Name:
DANIEL
Provider Middle Name:
J.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1740346121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42003-7914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-441-4750
Provider Business Mailing Address Fax Number:
270-441-4770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-7914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-441-4750
Provider Business Practice Location Address Fax Number:
270-441-4770
Provider Enumeration Date:
12/29/2006

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: 367500000X , with the licence number:  1110778 , 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: 000000506743 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100006300 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".