Provider Demographics
NPI:1063616720
Name:RONDA DENNIS-SMITHART, MD, PC
Entity type:Organization
Organization Name:RONDA DENNIS-SMITHART, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-673-7537
Mailing Address - Street 1:1417 A AVE E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-4202
Mailing Address - Country:US
Mailing Address - Phone:641-673-7537
Mailing Address - Fax:641-673-5235
Practice Address - Street 1:1417 A AVE E
Practice Address - Street 2:SUITE 100
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-4202
Practice Address - Country:US
Practice Address - Phone:641-673-7537
Practice Address - Fax:641-673-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24808208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty