1902298664 NPI number — SUSAN C. SMART, LM, CPM

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 1902298664 NPI number — SUSAN C. SMART, LM, CPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN C. SMART, LM, CPM
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:
1902298664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 JOLLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESNEE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29323-9167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-909-0042
Provider Business Mailing Address Fax Number:
864-285-0583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 FLOYD ROAD EXT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29307-1048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-909-0042
Provider Business Practice Location Address Fax Number:
864-285-0583
Provider Enumeration Date:
03/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SMART
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
LICENSED MIDWIFE, OWNER
Authorized Official Telephone Number:
864-909-0042

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  LMW0006 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LM0006 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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