1144209925 NPI number — WILLIAM H. SMITH-MENSAH M.D.

Table of content: WILLIAM H. SMITH-MENSAH M.D. (NPI 1144209925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144209925 NPI number — WILLIAM H. SMITH-MENSAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH-MENSAH
Provider First Name:
WILLIAM
Provider Middle Name:
H.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1144209925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 409013
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-9013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-377-8721
Provider Business Mailing Address Fax Number:
304-523-2241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11203 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41649-0910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-285-6400
Provider Business Practice Location Address Fax Number:
606-285-6629
Provider Enumeration Date:
01/11/2006

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: 207P00000X , with the licence number:  37654 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64057474 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000258423 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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