1790093284 NPI number — JANINE KRISTEN SMITH P.A.

Table of content: JANINE KRISTEN SMITH P.A. (NPI 1790093284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790093284 NPI number — JANINE KRISTEN SMITH P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
JANINE
Provider Middle Name:
KRISTEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOBLE
Provider Other First Name:
JANINE
Provider Other Middle Name:
KRISTEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790093284
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2595 CENTRAL AVENUE
Provider Second Line Business Mailing Address:
CHRIST COMMUNITY HEALTH SERVICES IN
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-260-8551
Provider Business Mailing Address Fax Number:
901-260-8590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2861 BROAD AVENUE
Provider Second Line Business Practice Location Address:
CHRIST COMMUNITY HEALTH SERVICES INC
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-260-8450
Provider Business Practice Location Address Fax Number:
901-260-8590
Provider Enumeration Date:
09/17/2010

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: 363A00000X , with the licence number:  1905 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1521009 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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