1912990888 NPI number — DAVID W SMITH MD

Table of content: DAVID W SMITH MD (NPI 1912990888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912990888 NPI number — DAVID W SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
DAVID
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1912990888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 MEDICAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-4646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-216-0164
Provider Business Mailing Address Fax Number:
850-216-0180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-4646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-216-0100
Provider Business Practice Location Address Fax Number:
850-216-0191
Provider Enumeration Date:
08/25/2005

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: 207RC0000X , with the licence number:  ME55402 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 027668 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00000 . This is a "1ST MEDICAL NETWORK" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00000 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00000 . This is a "UNITED HEATLH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 009978990 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00000 . This is a "FOCUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00000 . This is a "SOUTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0041756 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 061335500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00000 . This is a "BEECH STREET/CAPP CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00000 . This is a "HUMANA/CHOICE CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00000 . This is a "COMPHRENSIVE HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00000 . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 01280 . This is a "UNIVERSAL HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".