1831391663 NPI number — TERESA L. SMITH, MD, PC

Table of content: (NPI 1831391663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831391663 NPI number — TERESA L. SMITH, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERESA L. SMITH, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1831391663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 E BELLEFONTAINE RD
Provider Second Line Business Mailing Address:
PO BOX 70
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46742-9352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-488-2211
Provider Business Mailing Address Fax Number:
260-488-3046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 E BELLEFONTAINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46742-9352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-488-2211
Provider Business Practice Location Address Fax Number:
260-488-3046
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
260-488-2211

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01057213A , 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: 200452930A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15D1019601 . This is a "CLIA#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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