1922099357 NPI number — ROBERT E SMITLEY DO

Table of content: ROBERT E SMITLEY DO (NPI 1922099357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922099357 NPI number — ROBERT E SMITLEY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITLEY
Provider First Name:
ROBERT
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1922099357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1260 MONROE ST NW
Provider Second Line Business Mailing Address:
STE 1A
Provider Business Mailing Address City Name:
NEW PHILADELPHIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44663-4147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-743-2121
Provider Business Mailing Address Fax Number:
440-743-2122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6115 POWERS BLVD
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
PARMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44129-5471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-743-2121
Provider Business Practice Location Address Fax Number:
440-743-2122
Provider Enumeration Date:
11/03/2005

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: 2084P0800X , with the licence number:  34006357 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2019961 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".