Basic Information
| Provider Information | |||||||||
| NPI: | 1184952160 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREG SMITH MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 HUNTER STATION WAY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SELLERSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471728930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122484789 | ||||||||
| FaxNumber: | 8122484773 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 HUNTER STATION WAY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SELLERSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471728930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122484789 | ||||||||
| FaxNumber: | 8122484773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2009 | ||||||||
| LastUpdateDate: | 01/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8122484789 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 01033821 | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.