1679826010 NPI number — STARK COUNTY EMERGENCY PHYSICIANS

Table of content: KELLI MARIE SMITH MD (NPI 1891157400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679826010 NPI number — STARK COUNTY EMERGENCY PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STARK COUNTY EMERGENCY PHYSICIANS
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:
1679826010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5154 FULTON DR NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44718-2365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-499-8837
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5154 FULTON DR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44718-2365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-499-8837
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KAEBERLEIN
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
MD, VICE PRESIDENT
Authorized Official Telephone Number:
330-489-1365

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  363A00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com