1861464307 NPI number — DR. APRIL DAWN SVOBODA SMITH OD

Table of content: DR. APRIL DAWN SVOBODA SMITH OD (NPI 1861464307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861464307 NPI number — DR. APRIL DAWN SVOBODA SMITH OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SVOBODA SMITH
Provider First Name:
APRIL
Provider Middle Name:
DAWN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1861464307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 290
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIREN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54872-0290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-825-3974
Provider Business Mailing Address Fax Number:
715-349-2744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24082 STATE ROAD 35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIREN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-349-2733
Provider Business Practice Location Address Fax Number:
715-349-2744
Provider Enumeration Date:
02/07/2006

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: 152W00000X , with the licence number:  2729 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010724315011 . This is a "BCBS OF WI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 38604000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: C69931030008 . This is a "PREFERRED ONE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 2203121 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2204394 . This is a "MEDICA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 304535V . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP84006 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".




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