1932147691 NPI number — DR SMITH & ASSOCIATES 6958 P A

Table of content: RISTO EDWARD HURME D.D.S. (NPI 1174511182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932147691 NPI number — DR SMITH & ASSOCIATES 6958 P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR SMITH & ASSOCIATES 6958 P A
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:
1932147691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33743-0510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-361-0431
Provider Business Mailing Address Fax Number:
727-344-7952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13601 S DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-7219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-235-1721
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ENGEL
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
DIRECTOR OF ADMINISTRATION
Authorized Official Telephone Number:
727-361-0431

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 078682900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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