1629411780 NPI number — MR. JOSHUA JOE SMITH PTA

Table of content: MR. JOSHUA JOE SMITH PTA (NPI 1629411780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629411780 NPI number — MR. JOSHUA JOE SMITH PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
JOSHUA
Provider Middle Name:
JOE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PTA
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:
1629411780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1599 CALVIN WILSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAZEL
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42049-8637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-492-8333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 VOLUNTEER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38242-5472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-642-2535
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2013

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: 225200000X , with the licence number:  0000004869 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225200000X , with the licence number: A02598 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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