Basic Information
| Provider Information | |||||||||
| NPI: | 1689849275 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SMITH PHYSICIAN ASSISTANTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 FACTORY ST | ||||||||
| Address2: | PO BOX 91 | ||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136012729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157824207 | ||||||||
| FaxNumber: | 3157828699 | ||||||||
| Practice Location | |||||||||
| Address1: | 727 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136014031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157857009 | ||||||||
| FaxNumber: | 3157857566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2008 | ||||||||
| LastUpdateDate: | 04/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | MILAGROS | ||||||||
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| AuthorizedOfficialTitleorPosition: | RPA-C | ||||||||
| AuthorizedOfficialTelephone: | 3157857009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RPA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0057341 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.