1801992912 NPI number — BRIDGET F SMITH PHD

Table of content: BRIDGET F SMITH PHD (NPI 1801992912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801992912 NPI number — BRIDGET F SMITH PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
BRIDGET
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

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:
1801992912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1915 PROFESSIONAL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36830-2852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-826-1699
Provider Business Mailing Address Fax Number:
334-826-1629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1915 PROFESSIONAL CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36830-2852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-826-1699
Provider Business Practice Location Address Fax Number:
334-826-1629
Provider Enumeration Date:
09/15/2006

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: 103T00000X , with the licence number:  606 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GROUP MEDICAID # , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: MAGELLAN . This is a "MAGELLAN INSURANCE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: BCBS . This is a "51504454" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: INDIVIDUAL PROVIDER , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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