Basic Information
| Provider Information | |||||||||
| NPI: | 1710954789 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | STANLEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1926 ALCOA HWY | ||||||||
| Address2: | BLDG. F, SUITE 210 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655462663 | ||||||||
| FaxNumber: | 8655469047 | ||||||||
| Practice Location | |||||||||
| Address1: | 1926 ALCOA HWY | ||||||||
| Address2: | BLDG. F, SUITE 210 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655462663 | ||||||||
| FaxNumber: | 8655469047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 06/29/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD20463 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | 20463 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3052932 | 05 | TN | MEDICAID | TN0104 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | TN0176 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | 0940088 | 01 | TN | UNITED HEALTH CARE | OTHER | 100020893 | 01 | TN | TENNCARE | OTHER | TN0103 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | 64131071 | 05 | KY | MEDICAID | 200030082 | 01 | TN | RAILROAD MEDICARE | OTHER | 3071413 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 4631989 | 01 | TN | AETNA | OTHER |