Basic Information
| Provider Information | |||||||||
| NPI: | 1376767533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | TIFFANY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21850 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719031850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016092222 | ||||||||
| FaxNumber: | 5013219689 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MERCY LN | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016092222 | ||||||||
| FaxNumber: | 5013219689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 07/06/2016 | ||||||||
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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 | 207R00000X | E6142 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | E-6142 | AR | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 181077001 | 05 | AR | MEDICAID |