1235242678 NPI number — DARREN SCOTT SMITH O.D.

Table of content: DARREN SCOTT SMITH O.D. (NPI 1235242678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235242678 NPI number — DARREN SCOTT SMITH O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
DARREN
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
SCOTT
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235242678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 168
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40342-0168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-839-5113
Provider Business Mailing Address Fax Number:
502-839-9831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40342-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-839-5113
Provider Business Practice Location Address Fax Number:
502-839-9831
Provider Enumeration Date:
08/17/2006

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:  1390DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1169150 . This is a "CHA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 77013902 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00204906 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 9038878 . This is a "CIGNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000217614 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5089659 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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