Basic Information
| Provider Information | |||||||||
| NPI: | 1033187737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JOY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MILLER | ||||||||
| OtherFirstName: | JOY | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10330 S ROBERTS RD | ||||||||
| Address2: | MIDAMERICA HAND TO SHOULDER CLINIC | ||||||||
| City: | PALOS HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604651971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082377200 | ||||||||
| FaxNumber: | 7082377201 | ||||||||
| Practice Location | |||||||||
| Address1: | 10330 S ROBERTS RD | ||||||||
| Address2: | MIDAMERICA HAND TO SHOULDER CLINIC | ||||||||
| City: | PALOS HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604651971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082377200 | ||||||||
| FaxNumber: | 7082377274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 12/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 3314 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA19100 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | PA19100 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AS0400X | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | WPA19100B | 01 | CA | MEDICARE PTAN | OTHER |