1740247972 NPI number — DR. GREGORY C SMITH MD

Table of content: DR. GREGORY C SMITH MD (NPI 1740247972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740247972 NPI number — DR. GREGORY C SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
GREGORY
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1740247972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100523
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29501-0523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-669-5162
Provider Business Mailing Address Fax Number:
843-667-4573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W HAMLET AVE
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPT
Provider Business Practice Location Address City Name:
HAMLET
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28345-4522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-669-5162
Provider Business Practice Location Address Fax Number:
843-667-4573
Provider Enumeration Date:
05/01/2006

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: 2085R0202X , with the licence number:  38691 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 944274 . This is a "DESERET MUTUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: G49673 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 611473300 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1230K . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5902965 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203824712 . This is a "STANDARD TAX ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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