1326854985 NPI number — CHRISTINA CARZELL SMITH CAPRCII

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 1326854985 NPI number — CHRISTINA CARZELL SMITH CAPRCII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
CHRISTINA
Provider Middle Name:
CARZELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CAPRCII
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MINTON
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
CARZELL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CAPRCII
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326854985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 N HARRISON ST APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46001-1031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-701-2488
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2060 IN-1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-478-5411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2024

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: 175T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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