1487606729 NPI number — JOSEPH F SMIDDY M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487606729 NPI number — JOSEPH F SMIDDY M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SMIDDY

Provider First Name:

JOSEPH

Provider Middle Name:

F

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1487606729

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/24/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 90

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

COEBURN

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

24230-0090

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

276-455-5556

Provider Business Mailing Address Fax Number:

423-247-5254

Provider First Line Business Practice Location Address:

208 FRONT ST W

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

COEBURN

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

24230

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

276-455-5556

Provider Business Practice Location Address Fax Number:

276-455-5557

Provider Enumeration Date:

05/16/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RP1001X , with the licence number:  0101018713 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RP1001X , with the licence number: 33413 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: C05950 . This is a "TRAILBLAZER GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 055803 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 1738991 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 2005685 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 5983040 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 006014267 . This is a "VIRGINIA MEDICAID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 3153299 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 62134825602 . This is a "JOHN DEERE HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 64740723 . This is a "KENTUCKY MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 100023154 . This is a "PHP TENN CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".