1780601518 NPI number — R MACLEAN SMITH

Table of content: (NPI 1780601518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780601518 NPI number — R MACLEAN SMITH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R MACLEAN SMITH
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:
ALLERGY AND ASTHMA CLINIC
Provider Other Organization Name Type Code:
3
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:
1780601518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5126
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57117-5126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-335-1952
Provider Business Mailing Address Fax Number:
605-373-9971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 W 57TH ST STE 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57108-2288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-332-7000
Provider Business Practice Location Address Fax Number:
605-332-5455
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
MACLEAN
Authorized Official Title or Position:
PROVIDER AND OWNER
Authorized Official Telephone Number:
605-332-7000

Provider Taxonomy Codes

  • Taxonomy code: 207RA0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0006932 . This is a "BCBS GROUP" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 90741LA . This is a "BCBS GROUP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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