Basic Information
| Provider Information | |||||||||
| NPI: | 1760582951 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | W. B. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14883 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274154883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362754096 | ||||||||
| FaxNumber: | 3362683358 | ||||||||
| Practice Location | |||||||||
| Address1: | 1126 N CHURCH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369380800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 31386 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 2500415 | 01 | NC | UHC OF NC | OTHER | 8977968 | 05 | NC | MEDICAID | 77968 | 01 | NC | BCBS OF NC | OTHER | 1119 | 01 | NC | PARTNERS MEDICARE | OTHER | 82467 | 01 | NC | MEDCOST | OTHER |