Basic Information
| Provider Information | |||||||||
| NPI: | 1588645758 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACCHI-SMITH | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | R. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 LIBERTY HILL RD | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283582446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107393318 | ||||||||
| FaxNumber: | 9106713600 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 LIBERTY HILL RD | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283582446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107393318 | ||||||||
| FaxNumber: | 9106713600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 242134 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 201502231 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | A165 | 01 | NM | TRIWEST | OTHER | 107865100 | 01 | TX | FIRSTCARE COMMERCIAL | OTHER | BB4395895 | 01 | TX | DEA | OTHER | S6336 | 05 | NM | MEDICAID | 138868807 | 05 | TX | MEDICAID | 68866 | 05 | NM | MEDICAID | 80829Z | 01 | TX | HMO BLUE | OTHER | 107865101 | 05 | TX | MEDICAID | 86Z584 | 01 | TX | BC/BS | OTHER | L0072811 | 01 | TX | DPS | OTHER | 138868808 | 05 | TX | MEDICAID | 100008600A | 05 | OK | MEDICAID | 68866 | 01 | NM | PRESBYTERIAN COMMERCIAL | OTHER |