1659355089 NPI number — DR. DAMON LAMONT SMITH D.P.M.

Table of content: DR. DAMON LAMONT SMITH D.P.M. (NPI 1659355089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659355089 NPI number — DR. DAMON LAMONT SMITH D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
DAMON
Provider Middle Name:
LAMONT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1659355089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5412 NIGHTHAWK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46254-3712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-297-5940
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2346 S LYNHURST DR
Provider Second Line Business Practice Location Address:
STE 707
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46241-8605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-317-0711
Provider Business Practice Location Address Fax Number:
800-434-7113
Provider Enumeration Date:
11/30/2005

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: 213E00000X , with the licence number:  07000969A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200232900A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00095856 . This is a "TRAVELERS / RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 333781 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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