1851420442 NPI number — JACK D. SMITH, MD, LTD

Table of content: (NPI 1851420442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851420442 NPI number — JACK D. SMITH, MD, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACK D. SMITH, MD, LTD
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:
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:
1851420442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
133 DONOHOE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-6986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-834-4448
Provider Business Mailing Address Fax Number:
724-834-8563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 DONOHOE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-6986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-834-4448
Provider Business Practice Location Address Fax Number:
724-834-8563
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JACK
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-834-4448

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD015396E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103789 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3309195 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1948968 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0734802 . This is a "UNITED MINE WORKERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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