Basic Information
| Provider Information | |||||||||
| NPI: | 1366653321 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BILL MOORE SMITH MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 PINEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374052645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232650063 | ||||||||
| FaxNumber: | 4232651060 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 PINEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374052645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232650063 | ||||||||
| FaxNumber: | 4232651060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 10/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | BILL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4232650063 | ||||||||
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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 | 207Q00000X | 20573 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.