Provider Demographics
NPI:1124142153
Name:DRS. SMITH, SMITH AND MAUS, PC
Entity type:Organization
Organization Name:DRS. SMITH, SMITH AND MAUS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-372-5181
Mailing Address - Street 1:914 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-4530
Mailing Address - Country:US
Mailing Address - Phone:319-372-5181
Mailing Address - Fax:319-372-0865
Practice Address - Street 1:914 AVENUE G
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-4530
Practice Address - Country:US
Practice Address - Phone:319-372-5181
Practice Address - Fax:319-372-0865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1023083326OtherNPI LARRY D. SMITH, OD
IA1578538245OtherNPI CAROLYN R. SMITH, OD
IA1295714145OtherNPI KRISTIN K. MAUS, OD
IA0253040001Medicare NSC