1932597077 NPI number — FLOYD D SMITH, MD, INTERNAL MEDICINE, PS

Table of content: (NPI 1932597077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932597077 NPI number — FLOYD D SMITH, MD, INTERNAL MEDICINE, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLOYD D SMITH, MD, INTERNAL MEDICINE, PS
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:
1932597077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 868
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTRALIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98531-0868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-330-2023
Provider Business Mailing Address Fax Number:
360-623-1585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 KRESKY AVE
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98531-8982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-330-2023
Provider Business Practice Location Address Fax Number:
360-623-1585
Provider Enumeration Date:
12/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
FLOYD
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-330-2023

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  MD00019740 , registered in the state of WA ; 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