1306846597 NPI number — MR. JAMES B SMITH LICENSEDPSYCHOLOGIST

Table of content: MR. JAMES B SMITH LICENSEDPSYCHOLOGIST (NPI 1306846597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306846597 NPI number — MR. JAMES B SMITH LICENSEDPSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
JAMES
Provider Middle Name:
B
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICENSEDPSYCHOLOGIST
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:
1306846597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 BARTLETT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15217-1529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-723-3423
Provider Business Mailing Address Fax Number:
304-723-3426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2436 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
WEIRTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26062-3641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-723-3423
Provider Business Practice Location Address Fax Number:
304-723-3426
Provider Enumeration Date:
07/28/2005

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: 103TF0000X , with the licence number:  622 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0023528001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 550583609043 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: Y034223 . This is a "HEALTH PLAN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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