1235645607 NPI number — APPALACHIAN VASCULAR INSTITUTE, PLLC

Table of content: CARRIE JOY SMITH MSW (NPI 1235573072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235645607 NPI number — APPALACHIAN VASCULAR INSTITUTE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPALACHIAN VASCULAR INSTITUTE, PLLC
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:
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NPI Number Information

NPI Number:
1235645607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 ROY CAMPBELL DR STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAZARD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41701-9485
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-439-0051
Provider Business Mailing Address Fax Number:
606-439-0516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 ROY CAMPBELL DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-9485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-439-4433
Provider Business Practice Location Address Fax Number:
606-487-8035
Provider Enumeration Date:
12/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WELLS
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
606-439-0051

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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