1952395352 NPI number — MICHAEL L SMIT DO

Table of content: MICHAEL L SMIT DO (NPI 1952395352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952395352 NPI number — MICHAEL L SMIT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMIT
Provider First Name:
MICHAEL
Provider Middle Name:
L
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:
1952395352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6880 W SNOWVILLE RD STE 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRECKSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44141-3254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-565-5050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 MCKINLEY AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44703-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-458-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2005

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: 152W00000X , with the licence number:  0733 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X , with the licence number: 0733 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 34.012627 , 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: 09Y003825NH02 . This is a "ANTHEM NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 410047612 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30352041 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7366714001 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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