1114065844 NPI number — H MATT SMITH MD PS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114065844 NPI number — H MATT SMITH MD PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H MATT SMITH MD PS
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:
1114065844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 W 1ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336-3926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-585-5500
Provider Business Mailing Address Fax Number:
509-585-4161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 W 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-3926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-585-5500
Provider Business Practice Location Address Fax Number:
509-585-4161
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
HERBERT
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-585-5500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD00018280 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00358 . This is a "DEPT OF HEALTH EIP ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0801186563 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 836293000 . This is a "REGENCE BCBS OREGON" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0161428 . This is a "LABOR & INDUSTRIES ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 348362800 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2089786 . This is a "FIRST HEALTH ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4531768 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8937316 . This is a "CRIME VICTIMS ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1658905 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1266 . This is a "GROUP HEALTH COOP ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9250SM . This is a "REGENCE ASURIS ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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