1023495363 NPI number — MR. MATTHEW PHILIP SMITH MS, ATC

Table of content: MR. MATTHEW PHILIP SMITH MS, ATC (NPI 1023495363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023495363 NPI number — MR. MATTHEW PHILIP SMITH MS, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MATTHEW
Provider Middle Name:
PHILIP
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC
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:
1023495363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 COLLEGE AND MAIN
Provider Second Line Business Mailing Address:
CAPITAL ATHLETIC TRAINING
Provider Business Mailing Address City Name:
BEXLEY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43209-7812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-236-6622
Provider Business Mailing Address Fax Number:
614-236-6624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 COLLEGE AND MAIN
Provider Second Line Business Practice Location Address:
CAPITAL ATHLETIC TRAINING
Provider Business Practice Location Address City Name:
BEXLEY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43209-7812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-236-6622
Provider Business Practice Location Address Fax Number:
614-236-6624
Provider Enumeration Date:
05/06/2015

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: 2255A2300X , with the licence number:  4500 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2255A2300X , with the licence number: 1133 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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