1821202409 NPI number — CHERYL SMITH DO PC

Table of content: (NPI 1821202409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821202409 NPI number — CHERYL SMITH DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHERYL SMITH DO PC
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:
1821202409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14700 KING RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
RIVERVIEW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48193-7909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-759-0267
Provider Business Mailing Address Fax Number:
734-759-0272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14700 KING RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
RIVERVIEW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48193-7909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-759-0267
Provider Business Practice Location Address Fax Number:
734-759-0272
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
734-759-0267

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  5101013898 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 114351229 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7160324 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080190734 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0858208025 . This is a "BCBSMI INDIVIDUAL PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080H234390 . This is a "BCBSMI GROUP PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1073502928 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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