1205837069 NPI number — DR. CHRISTOPHER J SMITH M.D.

Table of content: DR. CHRISTOPHER J SMITH M.D. (NPI 1205837069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205837069 NPI number — DR. CHRISTOPHER J SMITH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
CHRISTOPHER
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
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:
1205837069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 635283
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-5283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-341-0288
Provider Business Mailing Address Fax Number:
859-341-7482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 NORTH GRAND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT. THOMAS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41075-1793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-912-7211
Provider Business Practice Location Address Fax Number:
859-655-6674
Provider Enumeration Date:
08/02/2005

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: 174400000X , with the licence number:  41585 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 41585 , 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: 0829072 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100044490 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000008876 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000560926 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0420604 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 634925 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00922874 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com