Basic Information
Provider Information | |||||||||
NPI: | 1750475836 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SMITH | ||||||||
FirstName: | STEVEN | ||||||||
MiddleName: | B | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2790 CLAY EDWARDS DR | ||||||||
Address2: | STE 1230 | ||||||||
City: | NORTH KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 641163253 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8162149300 | ||||||||
FaxNumber: | 8162149330 | ||||||||
Practice Location | |||||||||
Address1: | 2790 CLAY EDWARDS DR STE 1230 | ||||||||
Address2: |   | ||||||||
City: | N KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 641163253 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8168413805 | ||||||||
FaxNumber: | 8162149330 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/03/2006 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 2000143607 | MO | N |   | Suppliers | Durable Medical Equipment & Medical Supplies |   | 335E00000X | 2000143607 | MO | N |   | Suppliers | Prosthetic/Orthotic Supplier |   | 174400000X | 2000143607 | MO | Y |   | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 7593740001 | 01 | MO | DMEPOS LOCATION 1 | OTHER | 7593740002 | 01 | MO | DMEPOS LOCATION 2 | OTHER |