1518922509 NPI number — DR. STEPHANIE E. SMITH-PHILLIPS M

Table of content: DR. STEPHANIE E. SMITH-PHILLIPS M (NPI 1518922509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518922509 NPI number — DR. STEPHANIE E. SMITH-PHILLIPS M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH-PHILLIPS
Provider First Name:
STEPHANIE
Provider Middle Name:
E.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M
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:
1518922509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
570 LONG POINT RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29464-7930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-881-0320
Provider Business Mailing Address Fax Number:
843-881-5453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
570 LONG POINT RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-7930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-881-0320
Provider Business Practice Location Address Fax Number:
843-881-5453
Provider Enumeration Date:
04/20/2006

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: 207N00000X , with the licence number:  10896 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 108966 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: D470897818 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 10896 . This is a "SC INDIVIDUAL MEDICAL LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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