1861487365 NPI number — BYRON D SMITH MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861487365 NPI number — BYRON D SMITH MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BYRON D SMITH MD INC
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:
1861487365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 110
Provider Second Line Business Mailing Address:
73 W MAIN ST
Provider Business Mailing Address City Name:
CHILLICOTHEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45601-0110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-774-3023
Provider Business Mailing Address Fax Number:
740-774-3043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
272 HOSPITAL RD
Provider Second Line Business Practice Location Address:
ADENA REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
CHILLICOTHEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45601-9031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-779-7657
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
BYRON
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
740-774-3023

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0866666 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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