1114009073 NPI number — C.Y. SMITH & ASSOCIATES, INC

Table of content: (NPI 1114009073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114009073 NPI number — C.Y. SMITH & ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C.Y. SMITH & ASSOCIATES, INC
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:
6
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:
1114009073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4465 N OAKLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHOREWOOD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53211-1662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-354-3620
Provider Business Mailing Address Fax Number:
414-354-4972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1311 W 96TH ST
Provider Second Line Business Practice Location Address:
SUITE 121
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46260-1191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-918-5886
Provider Business Practice Location Address Fax Number:
414-354-4972
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
YVONNE
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
414-354-3620

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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