1912991258 NPI number — JAMES A.M. SMITH, DO

Table of content: (NPI 1912991258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912991258 NPI number — JAMES A.M. SMITH, DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES A.M. SMITH, DO
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:
1912991258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 48582
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67201-8582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-462-1070
Provider Business Mailing Address Fax Number:
316-462-1078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3730 N RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67205-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-462-1070
Provider Business Practice Location Address Fax Number:
316-462-1070
Provider Enumeration Date:
09/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A.M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
316-462-1070

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com