1427168632 NPI number — PAUL S SMITH CRNA

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 1427168632 NPI number — PAUL S SMITH CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
PAUL
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1427168632
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 372
Provider Second Line Business Mailing Address:
MASSACHUSETTS ANESTHESIA CORP.
Provider Business Mailing Address City Name:
STOUGHTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-341-3966
Provider Business Mailing Address Fax Number:
781-341-8269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
282 ROUTE 130
Provider Second Line Business Practice Location Address:
C/O CAPE COD EYE SURGERY & LASER CTR
Provider Business Practice Location Address City Name:
SANDWICH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-427-3720
Provider Business Practice Location Address Fax Number:
952-442-3620
Provider Enumeration Date:
08/30/2006

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: 367500000X , with the licence number:  185096 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 185098 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NA0363 . This is a "BLUE CROSS OF MASS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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