Provider Demographics
NPI:1215111679
Name:STEPHEN D SMITH MD PC
Entity type:Organization
Organization Name:STEPHEN D SMITH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAPLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-728-4292
Mailing Address - Street 1:2825 FORT MISSOULA RD
Mailing Address - Street 2:115
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7420
Mailing Address - Country:US
Mailing Address - Phone:406-728-4292
Mailing Address - Fax:406-728-5770
Practice Address - Street 1:2825 FORT MISSOULA RD
Practice Address - Street 2:115
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7420
Practice Address - Country:US
Practice Address - Phone:406-728-4292
Practice Address - Fax:406-728-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4309207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0043563Medicaid
MT0043563Medicaid