1740340017 NPI number — MRS. LAURA H SMITH FNP

Table of content: MRS. LAURA H SMITH FNP (NPI 1740340017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740340017 NPI number — MRS. LAURA H SMITH FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
LAURA
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

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:
1740340017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4131 CARMICHAEL RD
Provider Second Line Business Mailing Address:
SUITE 28
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36106-2801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-281-6363
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2460 CURTIS ELLIS DR
Provider Second Line Business Practice Location Address:
ATT: OPERATING ROOM
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27804-2237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-281-6363
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2006

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: 363LF0000X , with the licence number:  1-041326 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 190818 , 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: NC14940281 . This is a "MEDICARE NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: BO000077004 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2809812 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 14940281 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7000969 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: BOO51506240 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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