1386985307 NPI number — ARNOLD GRAHAM SMITH, MD PA

Table of content: (NPI 1386985307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386985307 NPI number — ARNOLD GRAHAM SMITH, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARNOLD GRAHAM SMITH, MD PA
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:
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:
1386985307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9191 R G SKINNER PKWY
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256-9655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-391-6862
Provider Business Mailing Address Fax Number:
904-391-1005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9191 R G SKINNER PKWY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32256-9655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-391-6862
Provider Business Practice Location Address Fax Number:
904-391-1005
Provider Enumeration Date:
03/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GOOSSEN
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMIN/VP
Authorized Official Telephone Number:
904-391-6862

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME0039103 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15651 . This is a "BCBS PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com