1114065844 NPI number — H MATT SMITH MD PS

Table of content: (NPI 1114065844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114065844 NPI number — H MATT SMITH MD PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H MATT SMITH MD PS
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:
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:
1114065844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 W 1ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336-3926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-585-5500
Provider Business Mailing Address Fax Number:
509-585-4161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 W 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-3926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-585-5500
Provider Business Practice Location Address Fax Number:
509-585-4161
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
HERBERT
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-585-5500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD00018280 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00358 . This is a "DEPT OF HEALTH EIP ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0801186563 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 836293000 . This is a "REGENCE BCBS OREGON" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0161428 . This is a "LABOR & INDUSTRIES ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 348362800 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2089786 . This is a "FIRST HEALTH ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4531768 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8937316 . This is a "CRIME VICTIMS ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1658905 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1266 . This is a "GROUP HEALTH COOP ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9250SM . This is a "REGENCE ASURIS ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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