1750413183 NPI number — MICHELE LINETTE SMITH LPT

Table of content: MICHELE LINETTE SMITH LPT (NPI 1750413183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750413183 NPI number — MICHELE LINETTE SMITH LPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MICHELE
Provider Middle Name:
LINETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPT
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:
1750413183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 PIN OAK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWANNANOA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28778-2775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-686-4452
Provider Business Mailing Address Fax Number:
828-686-4452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 EAGLE'S REACH DRIVE
Provider Second Line Business Practice Location Address:
BLUE RIDGE COMMUNITY COLLEGE
Provider Business Practice Location Address City Name:
FLAT ROCK
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28731-4728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-692-7068
Provider Business Practice Location Address Fax Number:
828-696-9722
Provider Enumeration Date:
03/12/2007

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: 225100000X , with the licence number:  7920 , 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: 7211194 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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