Basic Information
Provider Information | |||||||||
NPI: | 1043326762 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LEE E SMITH MD & ROBERT M JONES MDPC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 100 NEW HOPE RD | ||||||||
Address2: | SUITE 20 | ||||||||
City: | PRINCETON | ||||||||
State: | WV | ||||||||
PostalCode: | 247402143 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3044873407 | ||||||||
FaxNumber: | 3044872203 | ||||||||
Practice Location | |||||||||
Address1: | 100 NEW HOPE RD | ||||||||
Address2: | SUITE 20 | ||||||||
City: | PRINCETON | ||||||||
State: | WV | ||||||||
PostalCode: | 247402143 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3044873407 | ||||||||
FaxNumber: | 3044872203 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/23/2006 | ||||||||
LastUpdateDate: | 09/10/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SMITH | ||||||||
AuthorizedOfficialFirstName: | LEE | ||||||||
AuthorizedOfficialMiddleName: | E | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 3044873407 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |   |
ID Information
ID | Type | State | Issuer | Description | 0011475000 | 05 | WV |   | MEDICAID | 9917822 | 01 | WV | MEDICARE GROUP NUMBER | OTHER |