Basic Information
| Provider Information | |||||||||
| NPI: | 1720273782 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1125 PIERCE ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511051485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122558901 | ||||||||
| FaxNumber: | 7122559161 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 E 8TH ST STE 130 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457503379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403737197 | ||||||||
| FaxNumber: | 7403737198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2007 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35.135016 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.