1376767533 NPI number — TIFFANY SMITH MD

Table of content: TIFFANY SMITH MD (NPI 1376767533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376767533 NPI number — TIFFANY SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
TIFFANY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1376767533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21850
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71903-1850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-609-2222
Provider Business Mailing Address Fax Number:
501-321-9689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MERCY LN
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913-6442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-609-2222
Provider Business Practice Location Address Fax Number:
501-321-9689
Provider Enumeration Date:
04/12/2007

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: 207R00000X , with the licence number:  E6142 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: E-6142 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 181077001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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